Orlans HO, Hornby SJ, Bowler IC (2011) In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye Jan 21 [Epub ahead of print] PMID 21252952

Excerpt

Bacterial keratitis remains a major cause of corneal opacity and loss of vision worldwide. Topical antimicrobial therapy is critical to its management. A number of antimicrobials are available to treat bacterial keratitis, with new antimicrobials occasionally introduced to provide an improved spectrum of activity against emerging or resistant pathogens. For example, cephalosporins were introduced in the 1960s as resistance of Staphylococcus aureus to penicillin became common, while gentamicin was introduced in the 1970s mainly due to an upsurge in Pseudomonas aeruginosa infections, associated with increasing contact lens wear use [1]. The first- and second-generation fluoroquinolones (ciprofloxacin and ofloxacin) have excellent potency against Gram-negative bacteria and reasonably good activity against the Gram-positive bacteria, with little corneal toxicity. When the third- and fourth-generation fluoroquinolones (levofloxacin, moxifloxacin and gatifloxacin) became available in the early 2000s, they offered a broader Gram-positive cover [1‐3]. Despite the success of the first- and second-generation fluoroquinolones, there has been a trend in increased resistance from both S. aureus [4] and P. aeruginosa [5]. The fourth-generation fluoroquinolones, moxifloxacin and gatifloxacin, have not unfortunately been a treatment panacea because of the emergence of resistance [6]. …