Emerging Trends on Topical 4th Generation Fluorquinolones in Brazil

Abstract

Purpose: : To study culture results and antibiotic sensitivities of microorganisms isolated from conjunctivitis, keratitis and endophthalmitis from patients cultured after topical use of 4^th generation fluoroquinolones.

Methods: : Laboratory results from patients with conjunctivitis, keratitis, and endophthalmitis after topical use of gatifloxacin or moxifloxacin were studied. Gatifloxacin was introduced as a topical option for treatment of eye infection in September of 2003 while Moxifloxacin was introduced in September of 2004 The first patient under topical gatifloxacin with positive bacterial culture identified at the Microbiology Laboratory of Vision Institute – Federal University of São Paulo was a patient with conjunctivitis where Coagulase negative Staphylococcus (CNS) was isolated in November of 2003 and the total of 111 cases were included in this study . Moxifloxacin was introduced for ophthalmic use in Brazil in 2004 and the first positive culture was from a corneal sample where Mycobacteria and CNS were identified and 71 cases on Moxifloxacin were studied.

Results: : Patients under topical gatifloxacin (n=111) were studied based on their diagnosis of infection: 23 patients had conjunctival bacterial cultures and 14 ( 60 %) of them were positive, 66 patients had been under topical treatment for keratitis and 36 ( 54 %) of them were culture positive for bacteria; among 20 patients with endophthalmitis 4 ( 20 %) were positive. Among the topical Moxifloxacin treated patients (n= 71 ) 15 had conjuntival cultures with 12 (80 %) positive results, 44 patients with keratitis and 22 (50 % ) positive cultures and 12 with endophthalmitis 4 ( 30 %) had positive results . Were identified among these patients: 65 SCN; 13 Staphylococcus aureus; 9 Mycobacterium chelonae; 8 Streptococcus viridans; 3 Streptococcus pneumoniae; 2 Corynebacterium xerosis; Moraxella nonliquefaciens 2; 2 Gram positive bacilli; 1 Morganela morganii; 1 Haemoplilus influenzae; 1 Salmonella sp; 1 Escherichia coli. Resistance to fluoroquinolones was observed for 1 Streptococcus pneumoniae and 9 Mycobacteria chelonae.

Conclusions: : Even for patients on adequate topical treatment with 4^th generation fluorquinolones we were able to isolate bacteria from conjunctiva, cornea, anterior chamber and vitreous.

Keywords: antibiotics/antifungals/antiparasitics • bacterial disease • Staphylococcus