EyeWorld Asia-Pacific June 2019 Issue

EWAP JUNE 2019 35 SECONDARY FEATURE tant organisms collected. This step will help clinicians under- stand how and why the organ- isms are developing resistance. In industry, the development of new antifungals and antibiotics can be enhanced by studying the col- lected samples that actually have caused community infection. ACSIKS reveals antibiotic resistance patterns From the ACSIKS data, there appeared to be a difference in types of organisms and antibiotic resistance patterns among the countries studied. For the type of organism, developing countries like India, China, and the Philip- pines, to some degree, saw more fungal organisms in contrast to bacteria as the dominant organ- ism for developed countries (e.g., Singapore and Japan). Warmer climate countries and popula- tions with a greater number of contact lens wearers (such as Singapore and Taiwan) showed more gram-negative organisms than gram-positive organisms. On the other hand, data from Japan revealed more gram-positive organisms present in culture sam- ples. In Singapore, Thailand, and the Philippines, Pseudomonas aeruginosa was the primary or- ganism found. Overall, there were more gram-positive organisms than gram-negative ones. There also was significant variability in antibiotic resistance among different countries. More industri- alized countries, including Taiwan, Singapore, Korea, and Japan were found to have the lowest resistance to P. aeruginosa, with highest resistance in India, China, and the Philippines. Twenty one of 24 Pseudomonas isolates from India were resistant to multiple classes of antibiotics. Finally, the ACSIKS data revealed patterns in fluoroquinolone resistance. “The most resistant antibiotic to Pseudomonas aeruginosa was moxifloxacin, which is unfortunate because we use a lot of it in clini- cal practice,” Dr. Tan said. I n India: Public health interventions are crucial “The findings from ACSIKS give us some important tools as far as strategies that need to be adopt- ed in order to prevent blindness from corneal infections,” Dr. Garg said. The strategy Dr. Garg provided was to focus on public health education, especially in patients who are injured during farming or agriculture-related activities. He said that it is crucial for the community to be edu- cated on not using homemade remedies, which is the current practice in rural areas of India and other developing nations, and instead to seek proper medical treatment. If patients experience corneal ulcers progressing in size or if a physician has little or no experience treating these types of patients, they should be referred to advanced tertiary care centers. Within these tertiary care centers, two strategies should be adopted, Dr. Garg said. One is to constantly monitor antibiotic susceptibility of the isolates from these pa- tients, which will act as a guide for future patients presenting with corneal infections. Second, since the ACSIKS data showed that P. aeruginosa was resistant to multiple classes of antibiotics and that even fourth-generation fluoroquinolones are less effective against gram-positive organisms, these patients should be treated with combination therapy of ce- fazolin plus an aminoglycoside or a first-generation fluoroquinolone rather than monotherapy. Using combination therapy is helpful be- cause the chances of developing drug resistance goes down. Specifically for India, drug resistance has shifted to originate not only from hospitals but also from the community. According to Dr. Garg, this is due to the wide- spread use of antibiotics in poul- try and cattle feed. With proper government intervention, commu- nity-acquired antibiotic resistance can slowly be overcome. Dr. Garg outlines four strategies. First, the Indian government should place strict regulations on prescribing antibiotics. Although most physi- cians want to treat their patients with the most potent and recent antibiotics, the use should be re- stricted to the most serious cases rather than common infections. Second, the use of antibiotics in poultry and agriculture needs to be regulated. Third, physicians must adopt strategies to prevent the spread of these drug-resistant organisms, such as proper hand hygiene. Finally, there needs to be a constant surveillance and reporting of the resistance trends in antibiotic susceptibility. Furthermore, Dr. Garg is aware that the government is considering dispensing antibi- otics as prescription only, but because the health infrastructure in India is poor, the government has not taken aggressive action. It is crucial to constantly monitor prescription patterns of antibiotics in hospitals, periodically check antibiotic policies, and check how physicians comply to the antibiot- ic policies created. Continued on next page SPONSORED BY SANTEN PHARMACEUTICALS