Antibiotic resistance in ophthalmology is a rapidly growing phenomenon, which has recently been talked about and which for years has been neglected: the problem has often been treated and discussed for other branches of medicine but very little in ophthalmology and in relation to eye diseases, in which the use of antibiotics is widespread. This is testified by the data of a survey conducted by ‘DoT Tech’ for Théa Farma on 150 Italian ophthalmologists. The survey, carried out in the period November-December 2020, has revealed a recent photograph on antibiotic resistance in eye infections.
60% of the specialists involved defined antibiotic resistance as a relevant problem for ophthalmology, especially in the presence of conjunctivitis which turned out to be ocular surface infections with a higher incidence of bacterial resistance, followed by keratitis and blepharitis. both in the outpatient setting and in post-surgical prophylaxis.
“Ocular surface infections with a higher incidence of bacterial resistance are conjunctivitis. They are treated with antibiotic-based eye drops but often the therapy is not followed in the correct way and, consequently, resistance can be generated “, observes Luca Rossetti, director of the Eye Clinic of the San Paolo hospital in Milan.” The three fundamental rules for treating an eye infection are: trying to use the right antibiotic with the right dosage and for the right amount of time. The use for long periods of low dosages, which only serve to reduce the microbial load and increase the possibility of isolating resistant strains, not only does not cure the infection, but generates resistant bacterial colonies over time. When we have conjunctivitis that follow one another quickly it is logical to think of a relapse and in certain cases it will be necessary to resort to a conjunctival swab to precisely define the microbial agent and set up a targeted therapy “.
According to the data of the Survey, 98% of clinicians, considering their clinical case histories of the last 6 months of activity, reported antibiotic-resistance phenomena in a range of patients between 10% and 30%, i.e. about 50,000-100,000 patients per year. “Like all doctors, ophthalmologists have also been affected by this worldwide problem. Today we are beginning to understand that resistance is something that concerns us closely. The phenomenon is tangible and growing especially in the outpatient and when the patient presents with the red eye must be prescribed the antibiotic indicated to avoid inducing resistance “, says Vincenzo Orfeo, Head of the Ophthalmology Unit of the Mediterranean Clinic in Naples and Secretary of Aiccer (Italian association for cataract and refractive surgery).
“The first thing – he explains – is to try to understand if we are dealing with a bacterial form, to be treated with an antibiotic in full doses, a viral form or an allergy that should not be treated with antibiotics. Then think about the most suitable path. , using antibiotics which, as emerges from the literature, are not used at a systemic level but at a local level, more effective for the patient “.
In the scientific literature, there are three important international studies that have analyzed the phenomenon of antibiotic resistance in ophthalmology. “The studies on antibiotic resistance are very complex, especially those that examine the phenomenon at the ocular level. A recently published study carried out in patients treated at the Turin ophthalmic hospital between 1988 and 2017 highlighted an important and growing resistance trend towards different classes of antibiotics used in ophthalmology “, explains Scipione Rossi, Uoc director Ophthalmology, San Carlo di Nancy hospital in Rome and Aiccer Board Member.
“There are two other very important studies – continues Rossi – that outline the phenomenon: one from the US conducted between 2009 and 2018 on almost 6,000 patients in 88 sites, in which it was recorded how the phenomenon is spread evenly throughout the territory The second is an editorial from the American Academy of Ophthalmology from which it emerged that some patients who performed many intravitreal injections a year and who were therefore subjected to many antibiotic prophylaxis developed resistance to the products used “.
In Italy, resistance to antibiotics (according to AIFA data) remains among the highest in Europe and is, in most cases, above the European average. In our country, 7 to 10% of patients each year undergo a multidrug-resistant bacterial infection with thousands of deaths. Healthcare-related infections affect approximately 284,100 patients each year, causing approximately 4,500-7,000 deaths.
To find information on antibiotic resistance in eye infections, to listen to expert advice through video interviews, to access scientific studies published in the most important scientific journals in the sector, the website www.occhioalleresistenze.it has just been online. as a space to highlight and answer the problem. “Théa Farma is proud to be able to contribute to the awareness campaign on antibiotic resistance in ophthalmology”, says Luca Generoso, Product Manager Eye Infections for Théa Farma. “The creation of a dedicated site will not only provide useful information to Italian ophthalmologists, but also support them in the diagnostic and therapeutic process of patients with ocular infections. We consider it an act of awareness of the problem and strategies to prevent it, not only for well-being of all the patients who turn to the medical profession every day, but also for all of us “, he concludes.