title: Topical ophthalmic moxifloxacin elicits minimal or no selection of fluoroquinolone resistance among bacteria isolated from the skin, nose, and throat.
abstract: OBJECTIVE
  To investigate whether moxifloxacin therapy of bacterial conjunctivitis in children changes the moxifloxacin susceptibility of bacterial isolates in eyes, cheeks below eyes, nares, and throat.
  
  
  METHODS
  Patients (age: 1 to 12 years, n = 105) with bacterial conjunctivitis were treated topically with moxifloxacin three times a day for 7 days. Gender- and age-matched subjects with normal eyes (age: 1 to 12 years, n = 57) served as the control group. Microbiological specimens were collected on days 1 (prior to therapy), 8 (1 day after end of therapy), and 42 (follow-up). Specimens were processed to recover total bacteria and bacteria that grew on fluoroquinolone-selective media. Bacteria were identified to the species level and susceptibility to moxifloxacin and selected other antibiotics determined.
  
  
  RESULTS
  The primary pathogens recovered from the infected eyes on day 1 before therapy were Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus. None of the pre-therapy isolates of H. influenzae and S. pneumoniae were resistant to moxifloxacin. Isolates of these two pathogenic species were also recovered primarily from the nose and eyes. Moxifloxacin-resistant S. aureus isolates (minimum inhibitory concentration 1.0 μg/mL or greater) were recovered from the nose and throat prior to topical dosing on day 1. However, there was no change in the frequency of moxifloxacin-resistant isolates of S. aureus following treatment with moxifloxacin.
  
  
  CONCLUSIONS
  Treatment of conjunctivitis with topical ophthalmic moxifloxacin did not select for moxifloxacin resistance in H. influenzae, S. pneumoniae, or S. aureus in the eye or distal body sites.
authors.affiliation: University of Illinois College of Medicine at Peoria & Chicago, Children's Hospital of Illinois, Peoria, Illinois, USA. eyedoc44@aol.com
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lichtenstein
authors.forename: Liberation
authors.initials: L
authors.lastname: De Leon
authors.forename: Warren
authors.initials: W
authors.lastname: Heller
authors.forename: Bonnie
authors.initials: B
authors.lastname: Marshall
authors.forename: Gale
authors.initials: G
authors.lastname: Cupp
authors.forename: Kimberly
authors.initials: K
authors.lastname: Foster
authors.forename: Celeste
authors.initials: C
authors.lastname: McLean
authors.forename: Stuart
authors.initials: S
authors.lastname: Levy
authors.forename: David W
authors.initials: DW
authors.lastname: Stroman
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001372:Aza Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003234:Conjunctivitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D009297:Nasal Mucosa / Q000382:microbiology*; D009883:Ophthalmic Solutions; D010614:Pharynx / Q000382:microbiology*; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D012867:Skin / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D011804:Quinolines; D000077266:Moxifloxacin