Endophthalmitis is a vision-threatening complication that commonly occurs after cataract surgery. Visual outcomes are often debilitating, with 50% recovering 20/40 vision and about 30% being able to count their fingers.1 Because cataract surgery is the most commonly performed ocular procedure worldwide, postoperative endophthalmitis is an important public health issue associated with significant morbidity and high medical costs. Current prevention strategies in the United States include routine operating room aseptic protocols and perioperative topical antibiotic prophylaxis.2 However, recent studies of the past decade favor intracameral antibiotic administration, which involves a bolus injection into the anterior chamber at the end of surgery, …show more content…
due to a lack of a Food and Drug Administration approved intracameral antibiotic formulation. Consequently ophthalmologists who wish to apply intracameral antibiotics to their practice have turned to compounding antibiotics. Compounding of drugs is a process of mixing pharmacological ingredients with other reagents. Antibiotics meant for intravenous use is mixed with different solutions such as saline to obtain a solution for intracameral use. However, compounding of antibiotics must be formulated by licensed pharmacies that are capable of meeting the United States Pharmacopeial Convention’s standards to prevent dilution errors, contaminations, and other complications.11 Failure to be adhere to the USP’s standards can lead to a myriad of problems. Toxic anterior segment syndrome and permanent visual loss have been reported after dosing errors of intracameral antibiotics. Overdose of intracameral cefuroxime has been associated with severe uveitis and retinal vascular leakage.12 Intracameral vancomycin, in recent news, has also been suspected to cause dose-dependent ischemic retinal vasculitis after cataract surgery. Hence, safe and USP-compliant formulation is vital in preventing postoperative complications. Proper compounding of antibiotics requires …show more content…
Many researchers question the limitations of the ESCRS study and its application to the American patient population. Another large RCT is needed to demonstrate a statistically significant reduction in postoperative endophthalmitis with the use of a U.S. commercially manufactured intraocular antibiotic. However to date, no New Drug Application for an intracameral antibiotic preparation has been submitted to the FDA. It is proposed that the lack of interested commercial sponsors is a result of the likely insignificant economic return of such drug products.15 After all, antibiotics are categorized under the Food, Drug, and Cosmetic Act. The first manufacturer to invest and create an intraocular antibiotic preparation in the U.S. would not be granted a period of market exclusivity and thus would have no legal protection against
5. Poulin,P., et al.(2014) Preoperative Skin Antiseptics for preventing surgical site infections: What to do?
Plan of Care: No laboratory work ordered at this time. Patient prescribed Tobramycin ophthalmic ointment 1/4 to 1/2 inch ribbon to lower conjunctiva every four hours while awake (Medscape, 2014). Patient instructed to keep eye clean using a dilute baby shampoo solution twice daily. The patient is instructed to seek immediate medical intervention for visual changes, fever greater than 100.0, or increasing ocular pain. Return for follow-up appointment in two days (Goolsby & Grubs, 2011). Continue current medication regime as previously prescribed.
In 1999, there were amendments to the Optician’s Act. The amendments aimed to provide optometrists with a wider scope of practice, which allowed them to have limited clinical management of non- sight-threatening conditions such as allergic and infective conjunctivitis. It was thought that this might have helped to reduce the burden on the National Health Service. (GOC rules and regulations. (2017)).
Results: 252 and 116 patients were admitted for the first and second cohort respectively. In the first cohort, 120 (40.8%) of ophthalmic prescriptions vs. 1267 (83.6%) of non-ophthalmic prescriptions were correct; 48 (16.3%) vs 89 (5.9%) of eye drops vs non-ophthalmic medications were prescribed incorrectly; and 126 (42.9%) of ophthalmic prescriptions vs 160
Antibiotics differ from many other drugs in the fact that the treatment is for a very short time compared to drugs used to treat hypertension, diabetes, Parkinson’s, or cancer. The latter disorders have in common that the treatment, from the moment of diagnosis, is life-long. The treatment period for antibiotics is only a few weeks, making the return of investment poor. Increasing demands of authorities in both development and marketing phase and in legislation increase the costs of new antibiotics.[1] [3]
Future studies should concentrate on introducing intravenous antibiotics to pre-hospital setting, which would dramatically decrease the time interval to administration of antibiotics. However, safety, efficacy and cost-effectiveness would need to be taken into account through conducting randomized controlled trials to find out the effect on reducing delay, infection and occurrence of adverse effects
Antibiotics are inarguably one of the greatest advances in medical science of the past century. Although the first natural antibiotic Penicillin was not discovered until 1928 by Scottish biologist Alexander Flemming, evidence exists that certain plant and mold growths were used to treat infections in ancient Egypt, ancient India, and classical Greece (Forrest, 1982). In our modern world with the advent of synthetic chemistry synthetic antibiotics like Erithromycin and its derivative Azithromycin have been developed. Antibiotics have many uses including the treatment of bacterial and protozoan infection, in surgical operations and prophylactically to prevent the development of an infection. Through these applications, antibiotics have saved countless lives across the world and radically altered the field of medicine. Though a wonderful and potentially lifesaving tool, antibiotic use is not without its disadvantages. Mankind has perhaps been too lax in regulation and too liberal in application of antibiotics and growing antibiotic resistance is the price we must now pay. A recent study showed that perhaps 70% of bacterial infections acquired during hospital visits in the United States are resistant to at least one class of antibiotic (Leeb, 2004). Bacteria are not helpless and their genetic capabilities have allowed them to take advantage of society’s overuse of antibiotics, allowing them to develop
Research has revealed how overprescribing antibiotic creates several adverse outcomes, including the development of multidrug resistant organisms, Clostridium difficile infection, and increased costs of health care (Myung et al., 2015). The Consumer Report (2015) raised concern for the overuse of antibiotics and how it leads to the loss of the ability to treat serious infections. Doctors,
Although declining, inappropriate antibiotic prescribing continues to be a problem, especially the use of broad-spectrum antibiotics for infections of predominantly viral etiology, increasing risk for developing drug-resistant infection complications (Aspinall, Good, Metlay, Mor, & Fine, 2008; Garau & Dagan, 2003). Few interventions have been effective in moderating antibiotic overuse for acute URTIs (Legare et al., 2012). Emphasis on infection control alone is inadequate to address the rise of resistant infections. Judicious prescribing is the
It seems that human can start to overcome most of diseases by using antibiotics without any bad influence. But as time goes by, the side effects show up. The excessive use of antibiotics brings the disadvantages and problems with the heaps of advantages simultaneously. Antibiotics are not only exacerbating the health risk of animals, and human beings, but also exacerbating the environmental impairment. The antibiotics are used to treat and prevent diseases in human beings and animals’ medicine, but there are many kinds of risks deriving from the antibiotics therapies, which include the development and spread of resistant bacteria strains and environmental contamination; besides, the micro-biotic organism is also a big issue we need to concern about.
Eye drops and ointments are used to treat acute or long-term eye conditions. They are the main treatment for eye disease and are administered directly to the site of action making them more effective than other medications (Shaw, 2014). They can also be used to prevent or treat infection or inflammation, relieve discomfort, and prevent damage. It is important that patients understand eye medications need to be given the same priority as drugs administered per another route. They can cause interactions with other eye drops and medications delivered by other routes. It is essential that patients understand the time, route, and what eye the drops or ointments are to be instilled into.
With today's advances in medicine, silver nitrate application has been replaced with newer antibiotics for the treatment of neonatal conjunctivitis. These appear to have fewer side effects but similar efficacy. The question remains if the use of antibiotics is necessary at all, especially with the growing antimicrobial resistance we face today. As physicians, we must constantly ask the question "Do the benefits we seek today, truly outweigh the risks we may face tomorrow or in future generations."
Postoperative surgical site infections according to Nichol (2001) remain a major source of illness in surgical patients. Beaver, (2008) point out that surgical infection is one of the side effects that occur after a patient has gone for surgery.
Ethical challenges are the most profound when dealing with patient safety; compliance with the prophylaxis antibiotic administration guidelines is paramount to a surgical patient in order to decrease the possibility of a post operative surgical site infection. Antibiotic timing requires
Every day you come into contact with millions of disease infused microorganisms that could potentially bring harm to our bodies, but thanks to our amazing immune system, most of those diseases are destroyed before we develop symptoms. However, some of those microorganisms escape the wrath of our immune system and precede to harm our body. One of the diseases caused from microorganisms such as “Staphylococcus aureus, Streptococcus pneumonia, or Haemophilus” (NIH), can cause conjunctivitis. The more commonly known term for conjunctivitis is pink eye, which is the inflammation of the conjunctiva or outer layer of the eye.