Skip to main content
SpringerLink
Log in

Microbiological Etiology and Susceptibility of Bacterial Conjunctivitis Isolates from Clinical Trials with Ophthalmic, Twice-Daily Besifloxacin

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Bacterial conjunctivitis is a contagious infection of the surface of the eye usually treated empirically with topical antibiotics. Since the etiologic agent is rarely identified, it is important to monitor which bacteria cause conjunctivitis and determine their antibacterial resistance profiles.

Methods

A total of 496 bacterial samples were isolated during a randomized, double-masked, vehicle-controlled, parallel-group study conducted in the United States with besifloxacin ophthalmic suspension 0.6% dosed twice daily. Species were determined by standard biochemical and/or molecular identification methods. Minimum inhibitory concentrations were determined according to Clinical and Laboratory Standards Institute standards.

Results

The most prevalent species was Haemophilus influenzae, followed by Staphylococcus epidermidis, Staphylococcus aureus, the Streptococcus mitis group, and Streptococcus pneumoniae. One species identified in this study, which was not previously noted as a common cause of bacterial conjunctivitis, was Dolosigranulum pigrum. Ampicillin resistance was common among H. influenzae isolates, while macrolide resistance was high among S. pneumoniae, S. epidermidis, and S. aureus. The latter two species also included a number of isolates resistant to methicillin and ciprofloxacin.

Conclusion

Antibiotic resistance among isolates remains a concern and the appearance of an emerging ocular pathogen, D. pigrum, suggests the need for continued observation. The topical ophthalmic fluoroquinolones continue to provide a good balance of low to moderate (i.e., manageable) levels of resistance plus broad-spectrum coverage for empiric treatment of ocular infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tarabishy AB, Jeng BH. Bacterial conjunctivitis: a review for internists. Cleve Clin J Med. 2008;75:507–512.

    Article  PubMed  Google Scholar 

  2. O’Brien TP, Jeng BH, McDonald M, Raizman MB. Acute conjunctivitis: truth and misconceptions. Curr Med Res Opin. 2009;25:1953–1961.

    Article  PubMed  Google Scholar 

  3. Hovding G. Acute bacterial conjunctivitis. Acta Ophthalmol. 2008;86:5–17.

    PubMed  Google Scholar 

  4. Golde KT, Gardiner MF. Bacterial conjunctivitis in children: a current review of pathogens and treatment. Int Ophthalmol Clin. 2011;51:85–92.

    Article  PubMed  Google Scholar 

  5. American Academy of Ophthalmology. American Academy of Ophthalmology Cornea/External Disease Panel; Preferred Practice Pattern Guidelines. Conjunctivitis. San Francisco, CA: American Academy of Ophthalmology; 2008.

    Google Scholar 

  6. Haas W, Gearinger LS, Usner DW, DeCory HH, Morris TW. Integrated analysis of three bacterial conjunctivitis trials of besifloxacin ophthalmic suspension, 0.6%: etiology of bacterial conjunctivitis and antibacterial susceptibility profile. Clin Ophthalmol. 2011;5:1369–1379.

    PubMed  CAS  Google Scholar 

  7. Asbell PA, Colby KA, Deng S, et al. Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates. Am J Ophthalmol. 2008;145:951–958.

    Article  PubMed  Google Scholar 

  8. Haas W, Pillar CM, Torres M, Morris TW, Sahm DF. Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular micRorganisms (ARMOR) 2009 surveillance study. Am J Ophthalmol. 2011;152:567–574.

    Article  PubMed  CAS  Google Scholar 

  9. Cavuoto K, Zutshi D, Karp CL, Miller D, Feuer W. Update on bacterial conjunctivitis in South Florida. Ophthalmology. 2008;115:51–56.

    Article  PubMed  Google Scholar 

  10. Comstock TL, Karpecki PM, Morris TW, Zhang JZ. Besifloxacin: a novel anti-infective for the treatment of bacterial conjunctivitis. Clin Ophthalmol. 2010;4:215–225.

    Article  PubMed  CAS  Google Scholar 

  11. Carter NJ, Scott LJ. Besifloxacin ophthalmic suspension 0.6%. Drugs. 2010;70:83–97.

    Article  PubMed  CAS  Google Scholar 

  12. Bertino JS, Zhang JZ. Besifloxacin, a new ophthalmic fluoroquinolone for the treatment of bacterial conjunctivitis. Exp Opin Pharmacother. 2009;10:2545–2554.

    Article  CAS  Google Scholar 

  13. Haas W, Pillar CP, Zurenko GE, Lee JC, Brunner LS, Morris TW. Besifloxacin, a novel fluoroquinolone, has broad-spectrum in vitro activity against aerobic and anaerobic bacteria. Antimicrob Agents Chemother. 2009;53:3552–3560.

    Article  PubMed  CAS  Google Scholar 

  14. Haas W, Pillar CM, Hesje CK, Sanfilippo CM, Morris TW. Bactericidal activity of besifloxacin against staphylococci, Streptococcus pneumoniae and Haemophilus influenzae. J Antimicrob Chemother. 2010;65:1441–1447.

    Article  PubMed  CAS  Google Scholar 

  15. Sanfilippo CM, Hesje CK, Haas W, Morris TW. Topoisomerase mutations that are associated with high-level resistance to earlier fluoroquinolones in Staphylococcus aureus have less effect on the antibacterial activity of besifloxacin. Chemotherapy. 2011;57:363–371.

    Article  PubMed  CAS  Google Scholar 

  16. McDonald MB, Protzko EE, Brunner LS, et al. Efficacy and safety of besifloxacin ophthalmic suspension 0.6% compared with moxifloxacin ophthalmic solution 0.5% for treating bacterial conjunctivitis. Ophthalmology. 2009;116:1615–1623.

    Article  PubMed  Google Scholar 

  17. Karpecki P, DePaolis M, Hunter JA, et al. Besifloxacin ophthalmic suspension 0.6% in patients with bacterial conjunctivitis: A multicenter, prospective, randomized, doublemasked, vehicle-controlled, 5-day efficacy and safety study. Clin Ther. 2009;31:514–526.

    Article  PubMed  CAS  Google Scholar 

  18. Tepedino ME, Heller WH, Usner DW, et al. Phase III efficacy and safety study of besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial conjunctivitis. Curr Med Res Opin. 2009;25:1159–1169.

    Article  PubMed  CAS  Google Scholar 

  19. DeLeon J, Silverstein BE, Allaire C, et al. Besifloxacin ophthalmic suspension 0.6% administered twice daily for 3 days in the treatment of bacterial conjunctivitis in adults and children. Clin Drug Investig. 2012;32:303–317.

    Article  PubMed  Google Scholar 

  20. Silverstein BE, Allaire C, Bateman KM, Gearinger LS, Morris TW, Comstock TL. Efficacy and tolerability of besifloxacin ophthalmic suspension 0.6% administered twice daily for 3 days in the treatment of bacterial conjunctivitis: a multicenter, randomized, double-masked, vehicle-controlled, parallel-group study in adults and children. Clin Ther. 2011;33:13–26.

    Article  PubMed  CAS  Google Scholar 

  21. Cagle G, Davis S, Rosenthal A, Smith J. Topical tobramycin and gentamicin sulfate in the treatment of ocular infections: multicenter study. Curr Eye Res. 1981;1:523–534.

    Article  PubMed  Google Scholar 

  22. Leibowitz HM. Antibacterial effectiveness of ciprofloxacin 0.3% ophthalmic solution in the treatment of bacterial conjunctivitis. Am J Ophthalmol. 1991;112:29S–33S.

    PubMed  CAS  Google Scholar 

  23. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement M100-S21. 31. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute; 2011.

    Google Scholar 

  24. Adebayo A, Parikh JG, McCormick SA, et al. Shifting trends in in vitro antibiotic susceptibilities for common bacterial conjunctival isolates in the last decade at the New York Eye and Ear Infirmary. Graefes Arch Clin Exp Ophthalmol. 2011;249:111–119.

    Article  PubMed  CAS  Google Scholar 

  25. Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA. Manual of Clinical Microbiology. Washington, D.C.: ASM Press; 2007.

    Google Scholar 

  26. Leighton C, Piper D, Gunerman-King J. Pneumococcal conjunctivitis at an elementary school—Maine, September 20–December 6, 2002. MMWR Morb Mortal Wkly Rep. 2003;52:64–66.

    Google Scholar 

  27. Barker JH, Musher DM, Silberman R, Phan HM, Watson DA. Genetic relatedness among nontypeable pneumococci implicated in sporadic cases of conjunctivitis. J Clin Microbiol. 1999;37:4039–4041.

    PubMed  CAS  Google Scholar 

  28. Martin M, Turco JH, Zegans ME, et al. An outbreak of conjunctivitis due to atypical Streptococcus pneumoniae. N Engl J Med. 2003;348:1112–1121.

    Article  PubMed  Google Scholar 

  29. Sanfilippo CM, Haas W, Hesje CK, Morris TW. Strain ST448 causes the majority of pneumococcal conjunctivitis cases. Abstract A226. Paper presented at: Annual meeting of The Association for Research in Vision and Ophthalmology; May 6, 2012; Ft. Lauderdale, Florida, USA.

  30. Aguirre M, Morrison D, Cookson BD, Gay FW, Collins MD. Phenotypic and phylogenetic characterization of some Gemella-like organisms from human infections: description of Dolosigranulum pigrum gen. nov., sp. nov. J Appl Bacteriol. 1993;75:608–612.

    Article  PubMed  CAS  Google Scholar 

  31. Laclaire L, Facklam R. Antimicrobial susceptibility and clinical sources of Dolosigranulum pigrum cultures. Antimicrob Agents Chemother. 2000;44:2001–2003.

    Article  PubMed  CAS  Google Scholar 

  32. Tauber S, Cupp G, Garber R, Bartell J, Vohra F, Stroman D. Microbiological efficacy of a new ophthalmic formulation of moxifloxacin dosed twice-daily for bacterial conjunctivitis. Adv Ther. 2011;28:566–574.

    Article  PubMed  CAS  Google Scholar 

  33. Dong Q, Brulc JM, Iovieno A, et al. Diversity of bacteria at healthy human conjunctiva. Invest Ophthalmol Vis Sci. 2011;52:5408–5413.

    Article  PubMed  CAS  Google Scholar 

  34. Bertino JS. Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics. Clin Ophthalmol. 2009;3:507–521.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bausch & Lomb, 1400 North Goodman St., Rochester, NY, 14609, USA

    Wolfgang Haas, Lynne S. Gearinger, Christine K. Hesje, Christine M. Sanfilippo & Timothy W. Morris

Authors
  1. Wolfgang Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynne S. Gearinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine K. Hesje
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine M. Sanfilippo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy W. Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wolfgang Haas.

Additional information

To view enhanced content go to www.advancesintherapy.com

ClinicalTrials.gov #NCT00972777.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haas, W., Gearinger, L.S., Hesje, C.K. et al. Microbiological Etiology and Susceptibility of Bacterial Conjunctivitis Isolates from Clinical Trials with Ophthalmic, Twice-Daily Besifloxacin. Adv Therapy 29, 442–455 (2012). https://doi.org/10.1007/s12325-012-0023-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-012-0023-y

Keywords

Search

Navigation