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Download Current Controversies in Ocular Infection Management
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Antibiotics, Optometry and the Coming Armageddon Arthur B. Epstein, OD, FAAO Phoenix, AZ [email protected] In use since for less than a century, antibiotics have changed the way we live and how health care providers practice. This course explores current trends in infectious disease with focus on antibiotic therapy in eyecare. Discussion of potentially catastrophic trends in emerging antibiotic resistance and infection management will be explored. Course Outline 1) 2) How antibiotics work a) Overview b) The need for an intact immune system c) Superinfection d) What are the clinically relevant differences between different antibiotics? i) Spectrum ii) Efficacy iii) Kill rates iv) Penetration v) MIC and MBC vi) AUIC Current antibiotic therapy Fluoroquinolone vs. conventional antibiotic i) Should the “big guns” be saved for severe infections? ii) “Cornea specialist in a bottle” b) Differences between fluoroquinolones i) Marketing hype vs. clinical reality a) 3) Appropriate treatment: dosing a) Depends on clinical presentation and severity b) Depends on antibiotic being used c) Should an antibiotic be tapered i) What if it is an antibiotic-steroid combination? d) Length of treatment i) Rebound of some pathogens 4) 5) 6) Can ocular infection be prevented? a) Correlates of ocular infection i) Abrasion with infected materials ii) Contact lenses iii) Refractive surgery iv) Preexisting surface disease v) Dry eye b) Surgical Prophylaxis i) Does it work? ii) Is it important (1) Practical vs. medico-legal implications iii) Refractive surgery iv) Cataract and other ophthalmic surgery v) Punctal occlusion c) Care product selection and lens care practices in CL wearers The realities of today Emergent Resistance i) What is resistance? ii) How does it occur? iii) How significant is the problem in the optometric office? (1) Topical vs. systemic antibiotics (2) Inappropriate antibiotic choice (3) Environmental vs. clinical issues b) Avoiding resistance i) Conservative treatment strategies (1) Infection control strategies ii) Appropriate antibiotic choice iii) Patient communication a) Current antibiotic developments a) Controlled delivery vehicles b) Aganocides and other compounds that mimick natural defense against infection. c) Other strategies to enhance the effectiveness of existing antibiotics d) The pipeline for current and related classes of anti-infective agents