Op-Med is a collection of original articles contributed by Doximity members.
Speaker: Shahzad Mian, MD, University of Michigan
Session: Bacterial Keratitis: Are Fortified Antibiotics Still Necessary?
For most corneal ulcers these days, we’re able to use monotherapy with fluoroquinolone eye drops, because they’re readily available, they are less toxic to the surface of the eye and can manage most ulcers. However, there are still — we see a lot of ulcers where there’s more severity, more degree of inflammation, as well as more resistance to the different types of bacteria that are there. So we do still need to use fortified antibiotics in those cases.
So how do we decide? Usually, we make that decision based on, again, the clinical appearance as well as the region where we live. If we are seeing more resistant organisms in our microbiologic profile, then we’re more concerned and use the fortified antibiotics.
There are also some patients who have risk factors that increase their profile for where they need fortified antibiotics. So it be somebody who’s had prior refractive surgery or LASIK where they have an infection that is caused by a microorganism that is not able to be treated with the monotherapy with fluoroquinolones. You may also have patients who have already been previously treated with monotherapy and they’re not getting better. And that may be indication to use fortified drops.
There are also patients where you are suspecting other etiologies, not bacteria, like fungus or parasites. And in those cases, you do need to use medications, often, that are not commercially available. And so they have to be made more fortified.