Advances in Ocular Anti-infectives

Advances in Ocular Anti-infectives

Activity Date: June 24, 2011
Expiration Date: June 24, 2012

Activity Location: Internet

Target Audience: Ophthalmologists
This activity is intended for ophthalmologists with an interest in the treatment of ocular infectious diseases, such as acute bacterial conjunctivitis, acute viral keratoconjunctivitis, trends in antibiotic and antiviral treatment, and pharmacokinetics.

Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
Lippincott CME Institute, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Non-physician Credit Designation
The Council on Optometric Practitioner Education (COPE) CE Course #31817-AS – Event #102448 approves this online course for 1.0 credit hour, after completion of continuing education exam of 70% and higher, with certification by Nova Southeastern University, School of Optometry. Office of Continuing Education, Fort Lauderdale, FL 33328. CE certificates will be mailed 4-6 weeks after completion of the exam. Optometrists should contact their state licensing board for approval of this online course for Continuing Education credit.

Commercial Support
This CME activity is supported in part by an educational grant from Bausch & Lomb.

In-Kind Support
LCMEI received in-kind support from Ophthalmology Management magazine in the form of reduced advertising rates.

Statement of Need
Antibiotic therapy in ophthalmological practice has developed along a unique path over the years distinct from that seen in other medical and surgical specialties. The delicate permeability of the tissues of the eye has allowed topical antibiotic therapy to become the mainstay of treatment for many types of ocular infection. While systemic antibiotic therapy — and more recently the use of local delivery of antibiotics — play a vital role in the care of severe ocular infections, topical therapy continues to remain the most efficient mode to prevent and cure infection in ophthalmological practice.

Infections in the eye commonly require antibiotic therapy. Older classes of drugs that were once the standard of care are now being confronted by the specter of resistant organisms.

Given the increasing incidence of ocular infections, particular those caused by organisms resistant to standard therapy, and evolving data regarding safe and effective strategies for prevention and treatment, there are clear opportunities to help ophthalmologists improve their practice and patient care. The war against microbial pathogens is a never-ending one. In ophthalmological practice, there is great urgency to keep infection at bay in light of the immunologically privileged anatomy of the eye. Eye specialists are faced with resistant organisms as a matter of course, and they must stay abreast of the newest developments and how to apply them in practice to ensure the best care for their patients.

Presenter Terrence O'Brien, professor of ophthalmology, and director of the refractive surgery service at Bascom Palmer Eye Institute, will evaluate the qualities of the ideal anti-infective for the eye.1 Dr. O'Brien will emphasize that an antibiotic should be broad spectrum, preferably bactericidal versus bacteriostatic, biocompatible, bioavailable, and have favorable pharmacodynamics. By biocompatible, Dr. O'Brien means anti-inflammatory properties of certain antibiotics that offer another line of defense against infection in addition to their ability to kill microbial pathogens. The synergistic effects of such an agent would speed recovery and reduce the potential for developing resistance. Dr. O'Brien will discuss that an assessment of the pharmacodynamics of new antibiotics is a vital part of their development and subsequent integration into practice. Pharmacodynamic considerations also include the use of different delivery systems to extend the level of drug for the most beneficial result.

The ideal doses of antibiotics can be calculated in various ways, and the resulting values are highly specific for each organism, allowing the comparison of the effectiveness of different types of drugs.2

A newer PD concept — mutant-prevention concentration (MPC) — may become more widely used in the future.3 The MPC defines the antimicrobial drug concentration threshold that would require an organism to possess two mutations simultaneously for growth in the presence of the drug. Based on results from research done on fluoroquinolones, use of MPC may allow clinicians to determine the ideal dose and simultaneously the dose that would suppress the emergence of resistant strains — much needed knowledge to improve patient care.

Addressing Physician Competencies
This activity will help physicians address the following competencies:

Core Competencies adopted by the American Board of Ophthalmology as the basis for
Maintenance of Certification4

  • Evidence of professional standing
  • Evidence of a commitment to lifelong learning and self-assessment

Core Competencies adopted by the American Board of Medical Specialties5

  • Patient care
  • Medical knowledge

Core Competencies adopted by the Institute of Medicine6

  • Provide patient-centered care
  • Employ evidence-based practice

Faculty Credentials and Disclosure Information
Unless otherwise noted below, the speaker's spouse/life partner (if any) has nothing to disclose.

Terrence P. O'Brien, MD
Professor of Ophthalmology
Charlotte Breyer Rodgers Distinguished Chair in Ophthalmology
Director of the Refractive Surgery Service
Bascom Palmer Eye Institute of The Palm Beaches
Palm Beach Gardens, FL

Dr. O'Brien has disclosed that he was/is a consultant/advisor to Alcon, Allergan, Abbott Medical Optics, Bausch & Lomb, Inspire Pharmaceuticals, Ista Pharmaceuticals, Santen, and Vistakon.

All LCMEI staff members in a position to control the content of this CME activity have disclosed that they and their spouse/life partners (if any) have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Identification and Resolution of Conflicts of Interest
Lippincott CME Institute, Inc., has identified and resolved any faculty conflicts of interest regarding this educational activity.

Off-label Use/Unapproved Drugs or Products
The faculty has disclosed that the U. S. Food and Drug Administration has not approved the use of gatifloxacin, moxifloxacin, and besifloxacin for the treatment of ocular infections and will disclose this to the audience. Use of any commercial product should be undertaken only after confirmation of information by consulting the FDA-approved indications, labeling and other authoritative information.

Clinicians should ensure that all diagnostic and therapeutic modalities are prescribed and used appropriately, based on accepted standards of care. Use of any drugs, devices, and imaging techniques should be guided by approved labeling/full prescribing information, best available evidence, and professional judgment.

Faculty have been instructed that their content should be fair balanced and based on best available evidence. The information presented in this activity is the responsibility of the faculty and does not reflect the opinions of the provider or supporter.

Learning Objectives
After participating in this CME activity, ophthalmologists should be better able to:

  • Demonstrate knowledge of the most frequent pathogens causing conjunctivitis in humans
  • Interpret recent epidemiological data demonstrating increasing antimicrobial resistance among ocular pathogens
  • Analyze mechanisms of action of fluoroquinolones and mechanisms of resistance to understand agent differentiation and potential clinical implications
  • Develop a rational evidence-based treatment plan for suspected infection of the ocular surface
  • Evaluate the epidemiology of herpetic eye disease
  • Analyze structure and function of newer ophthalmic antiviral agents
  • Interpret clinical data demonstrating efficacy and safety of ganciclovir ophthalmic gel
  • Develop an algorithmic evidence-based treatment approach to herpetic eye disease

Getting the Most out of the Activity
As you prepare to participate in this activity, please reflect on your practice and your patients with retinal diseases and identify clinical challenges you hope to have addressed.

While participating in the conference, identify ways you can use newly acquired knowledge, strategies, and skills to enhance patient outcomes and your own professional development.

Method of Physician Participation
To earn CME/CE credit, a participant must register, view the entire activity online, and complete the evaluation questionnaire. A certificate will be available for print once a participant completes and submits the post exam with a passing score. Send questions to or request further information regarding CME/CE credit from the Office of Continuing Education, Lippincott Continuing Medical Education Institute, Inc., Two Commerce Square, 2001 Market Street, 3rd floor, Philadelphia, PA 19103; fax: (215) 827-5614.

System Requirements:
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WINDOWS 98/2000/XP
Internet Explorer 5.0 and above
Opera 7.0
Firefox 1.0
Netscape 7.2 and above

Internet Explorer 5.2.3 and above
Opera 7.54
Firefox 1.0.4
Netscape 7.2 and above
Safari 1.2.4

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Educational Outcomes Analysis Plan

Lippincott CME Institute, Inc., will provide learners with an evaluation questionnaire that will allow them the means to assess the activity's quality, whether the goals of the activity were met, fairness and balance, and the effect on physician clinical practice behavior of the educational activity. A follow-up survey will be sent to participants a few months after the conference. Lippincott CME Institute, Inc., will compile and analyze the evaluation data, share the data with the conference planners, and utilize that data in the development of future CME activities.


1. ASCRS 2008- EyeWorld Breakfast-O'Brien available at
EYESPACEMD/pdf/2/08chicago-2-obrien-TheAntiinfectious. pdf+dr+terrence+o%27brien+ascrs+2008&hl=en&gl=ca&pid=bl&srcid=ADGEESj4tSAYLB

2. Wright DH, Brown GH, Peterson ML, Rotschafer JC. Application of
fluoroquinolone pharmacodynamics. J Antimicrob Chemother. 2000;
3. Wright DH, Brown GH, Peterson ML, Rotschafer JC. Application of fluoroquinolone pharmacodynamics. J Antimicrob Chemother. 2000;
4. American Board of Ophthalmology. Visit
5. American Board of Medical Specialties. Visit
6. The Institute of Medicine's Health Professions Education Report. Visit

I have read the guidelines outlined.