Fluoroquinolones: place in ocular therapy

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pharmacology

Background:

• Fluoroquinolones are widely used for ocular infections via topical, intravitreal, and systemic routes.
• They exhibit broad-spectrum activity against Gram-negative and Gram-positive bacteria.
• Fluoroquinolones have largely replaced combination therapy for bacterial keratitis due to effective corneal penetration.

Purpose of the Study:

• To review the efficacy and safety of fluoroquinolones in treating ocular infections.
• To highlight the importance of judicious prescribing to mitigate antimicrobial resistance.
• To assess fluoroquinolone penetration and toxicity in ocular tissues.

Main Methods:

• Review of existing literature on fluoroquinolone use in ophthalmology.
• Analysis of pharmacokinetic data regarding corneal and vitreous penetration.
• Evaluation of reported clinical outcomes and toxicity profiles.

Main Results:

• Therapeutic concentrations are achieved in the cornea, making them effective for bacterial keratitis.
• Corneal and retinal toxicity are not observed at therapeutic dosages.
• Corneal precipitation, especially with ciprofloxacin, does not impede healing.
• Systemic fluoroquinolones show reasonable vitreous penetration for endophthalmitis, but concentrations may not always reach MIC90 for all pathogens.

Conclusions:

• Fluoroquinolones are valuable agents for ocular infections, with minimal toxicity at therapeutic doses.
• Resistance to fluoroquinolones is a growing concern, necessitating careful prescribing practices.
• Systemic fluoroquinolones may be beneficial for prophylaxis in post-ocular trauma cases.