Anti- Bacterials

Question 1

what are the two antibacterials you could use

Answer 1

cholromphenicol

and fusidic acid

in the uk most common line of antibacterial used is chloramphenicol because of the cost (it is much cheaper)than fusidic acid

Question 2

what are the antibacterials used for

Answer 2

used in the treatment of bacterial conjunctivitis typically on acute presentation

Question 3

what presentations of conjunctivitis wont respond to antibacterials

Answer 3

viral forms of conjunctivitis particularly those from Adeno virus

Question 4

what are the two antimicrobial drugs available for orthoptists

Answer 4

the only anti microbial made available to orthoptists are antibacterial drugs and of these two are available for the treatment of acute bacterial conjunctivitis and the prophylactic management of corneal abrasion

Question 5

what dosage of chloramphenicol can you use

Answer 5

0.5% minims or 1% ointments , P medicine when supplied to children over 2 years old and adults. POM in under 2 years

Question 6

what dosage of fusidic acid is used

Answer 6

1% modified release. Contains benzalkonium chloride as preservative, very expensive so considered as second line medication or in cases of known chloramphenicol contraindication

Question 7

how prevalent is ABC (acute bacterial conujuctivits)

Answer 7

approximately 78% of acute infectious conjunctivitis in children are cases of bacterial conucitivits (Chen et al 2023)

Question 8

what does acute bacterial conjuctivitis present as

Answer 8

usually presents as bilateral pink eye (due too conjunctival infection) with mucopurlent discharge

the lids are typically stuck together overnight and the discharge forms and dries so crusting on the lashes

the vision is not affected (or only minimally due to compromised tear film) and the eye maybe irritable, but no painful

anterior chamber is clear and there are no associated lymph andenopathies

it is not usually associated with an unwell child (unlike viral conjuctvitis) which may co present with a febrile child

Question 9

what history would you expect with a presentation of acute bacterial conjunctivitis

Answer 9

due to the highly contagious nature of the disease, there may be history of recent contact with a person who had bacterial coonjuvitis , it is most commonly spread through contaminated fingers , thus emphasising the importance of hand hygienie to those diagnosed with an acute bacterial conjcutvitis

Question 10

what is important for diagnosis

Answer 10

the accurate diagnosis of acute bacterial conbjcutivits is essential and the practiser must rule out potentially sight threatening disease prior to arriving at a diagnosis

if necessary , this may require obtaining a conjunctival culture and is particularly important for infectious neonatal conjucvitics , when an ophthalmologist opinion Is imporant

Question 11

how long do the signs of acute bacterial conjunctivitis typically last

Answer 11

they usually last less than three- 4 weeks

Question 12

what are the most common pathogens involved in acute bacterial conjuctiits for adults and childreen

Answer 12

the more common pathogen for adults in staphylococcus aureus whereas sreptoscocculs p neumonaie

Question 13

what does the department of health say about acute bacterial conjunctivitis say about treatment

Answer 13

acute bacterial conjunctivitis is a self limiting disease nd is not sight threatening it will resolve without intervention in approximately 7-10 days (department of health)

presents a problem of supplying an antimicrobial to the parent or carer or wait remission of the infection without intervention

Question 14

what concerns does treating acute bacterial conjunctivitis with antimicrobials rise

Answer 14

antimicrobial resistance

Antimicrobial resistance (AMR) refers to the ability of microorganisms, such as bacteria, viruses, fungi, and parasites, to evolve and develop resistance to the drugs or antimicrobial agents that were originally effective at treating infections caused by these microorganisms. In other words, these microorganisms become resistant to the drugs that were once able to kill or inhibit their growth.

Antimicrobial resistance is an escalating problem (NICE, 2015) and is given due attention in the Department of Health in “UK Five Year Antimicrobial Resistance Strategy 2019 to 2024” (Department of Health, 2019).
In this document the strategies ‘optimising prescribing practice and improving professional education, training and public engagement are of particular relevance here

Question 15

what does evidence say about treating conjcutivits with antimicrobials

Answer 15

it was found that the use of antimicrobials were benefit in improving early (days two - five) clincial and microblogical remission rates

at the ‘‘late’’ time point (days six to 10) antibitocs were also showing a modest improvement in clinical and microbiological remission rates

it should be noted that neither course of treatment was associated with any severe ocular outcomes

Question 16

what has recent evidence said about the clinical and microblogical cure times using anti microbial

Answer 16

the most recent Cochrane review has shown further support for the use of antibiotics for acute bacterial conjuctivitis

it shows reduced clinical and microbiology al cure times and antibiotic use was associated with better completion of therapy compared with placebo

the authors reckoned the use of antibiotics for the treatment of acute bacterial conjucvtiis

Question 17

what does antimicrobial stewardship say about the use of antimicrobials in treatment,

Answer 17

antimicrobial stewardship promotes the effective use of antimicrobials (including antibiotics) in children , young people and adults and aims to change preserving practice to help slow emergence of antimicrobial resistance and ensure that antimicrtobials remain an effective treatment for infection

in addition patient expectations also need to be modified, it is quite common for carers to expect to receive a medicinal product when there is a obvious disease and this needs to change in cases of acute bacterial conjunctivitis

Question 18

what is the current treatment regime for treatment of acute bacterial conjuctivitis

Answer 18

in general chooloramhenicol 0.5% eye drops are supplied

for children and adults it is recommend to apply one drop every 2hrs then reduce the frequency as infection is controlled and continue for 48hrs after healing , the frequency of installation being dependent on the severity of the infection

for less severe infections three to four times daily is generally sufficent

Question 19

what is the alternative treatment regime for the treatment of acute bacterial conjuctivitis

Answer 19

an alternative is the 1% chloramphenicol eye ointment which can be applied at night for sever infections (in addition to eye drops used during the day)

this ointment can alternatively be applied three to four times a day , if ointment alone is used and these doses apply to both adults and children

fusidic acid 1% eye drops are to be applied twice daily for both adults and children

Question 19

what are the contraindications to the use of chloramphenicol

Answer 19

chloramphenicol is contraindicated in pregnancy and breast feeding mothers

this is due to the risk of the infant ‘‘grey baby syndrome’’ which can be fatal

it is also contraindicated in patients with a history of blood dyscrasias due to the association with aplastic anaemia

indeed chloramphenicol is rarely used in the use due to this association

however it seems cases involving eye drops are extremely rare (Walker et al 1998)

Question 20

in cases of mothers who are pregnant and Brest feeding mothers what antibiotic should you supply

Answer 20

in these cases fusidic acid is the drugs of choice you should decide to supply

fusuidc acid does not pose the same risks and is only contraindicated in patients with a known sensitivity to it or to any component - benzakolnium cholirse

Question 21

how should chloramphenicol minims be stored

Answer 21

cholramphenicol minims need out be stores between 2-8 degrees , if stored at room temperature they must be used within 28 days

Question 22

how should fusidic acid be stored

Answer 22

fusidic acid should be stored below 25 degrees