Biomedical & Pharmacology Journal Vol.

9(2), 599-604 (2016)

Prescription Pattern of Antibiotics and Susceptibility

of the Pathogens in Infectious Conjunctivitis
NIMMALA SUPRITHA1, S. MOHAPATRA2* and R. JAMUNA RANI2

1
Intern, SRM Medical College Hospital & Research Centre, Tamilnadu, India.
2
Department of Pharmacology, SRM Medical College Hospital & Research Centre, Tamilnadu, India.
*Corresponding author E-mail: [email protected]

http://dx.doi.org/10.13005/bpj/978

(Received: March 28, 2016; accepted: May 01, 2016)

ABSTRACT

Conjunctivitis is usually of infective origin and is caused by bacteria, virus or chlamydia.

Antibiotics are mainly prescribed for quick recovery of the patient and for speeding up the eradication.
This study was done to evaluate the prescribing pattern of antibiotics in the patients with conjunctivitis
and to know the susceptibility of the pathogens to the antibiotic.Based on the inclusion and
exclusion criteria, fifty subjects who are having conjunctivitis were selected and evaluated for the
prescribing pattern of antibiotics.Conjuctival swab was collected and inoculated in the culture
media. The cultures were analysed for growth and the organism was identified based on gram
staining and tests. The antibiotic sensitivity tests were done by disc diffusion method.
Flouroquinolones were the most commonly prescribed antibiotics (94%). Among the
flouroquinolones, Moxifloxacin was the most commonly (52%) prescribed drug.Staphylococcus
aureus has the highest occurrence (92.3%) followed by P. aeruginosa at 4% isolated from the
conjuctival swab.Moxifloxacin has the highest zone of inhibition followed by ciprofloxacin and
ofloxacin in S.aureus isolates. Antibiotics were correctly prescribed in case of conjunctivitisof
bacterial origin and antibiotics were assumed to be prescribed to prevent secondary infections in
suspected case of viral origin.

Key words: Prescription pattern, Antibiotics, Conjunctivitis

INTRODUCTION up the eradication of bacteria and decreases risk

of spread.3,6The health care providers routinely
Conjunctivitis is defined as the prescribeantibiotics before identifying the causative
inflammation of the conjunctiva. It is usually of organism by bacterial culture or performing an
infective origin may be of bacterial, viral or antibiotic susceptibility test of the identified organism.
chlamydial. The most common bacterial micro- But in daily practice, the bacterial culture is not
organisms include Staphylococcus aureus , feasible because of the diagnostic delay and the
Streptococcus pneumonia, Hemophilusaegyptius, patient needs quick relief from the ocular discomfort.
Cornybacterium diphtheria, Neisseria Therefore, the antibiotics prescribed are mostly
gonorrhoeae, Moraxella lacunata, etc. Infectious broad spectrum antibiotics and have a topical route
conjunctivitis presents with hyperemia of varying of administration.The common antibiotics (topical)
degree, mucopurulent discharge,itching, irritation, indicated in infectious conjunctivitis includes
foreign body sensation, matting of eyelashes and fluoroquinolones (e.g., ciprofloxacin, levofloxacin,
crusting of eyelids.1,2Generally, this condition is ofloxacin, moxifloxacin), aminoglycosides (e.g.,
usually self-limiting and benign but the clinical gentamicin and tobramycin) polymyxin-based
course of the infection can be shortened by using combinations (e.g., polymyxin B sulfate and
antibiotic agents. Not only does the use of antibiotics trimethoprim), azithromycin and chloramphenicol.6,7
help in quick recovery of the patient, it also speeds
 POLA RESEP ANTIBIOTIK DAN KERENTANAN PATOGEN PADA
KONJUNGTIVITIS INFEKSI

NIMMALA SUPRITHA1,S.MOHAPATRA2* DAN, JAMUNA RANI2

ABSTRAK

Konjungtivitis biasanya infektif dan disebabkan oleh bakteri, virus atau klamidia. Antibiotik hanya diresepkan
untuk mempercepat penyembuhan pasien dan untuk mempercepat pemberantasan. Penelitian ini dilakukan untuk
mengevaluasi pola resep antibiotik pada pasien dengan konjungtivitis dan untuk mengetahui kerentanan patogen
terhadap antibiotik. Berdasarkan pada kriteria inklusi dan eksklusi, lima puluh subyek yang menderita konjungtivitis
dipilih dan dievaluasi pola peresepan dari antibiotik. Swab konjungtiva dikumpulkan dan diinokulasi dalam media
kultur. kultur dianalisis untuk melihat pertumbuhan dan organisme diidentifikasi berdasarkan tes dan pewarnaan
gram.. Tes sensitivitas antibiotik dilakukan dengan metode cakram difusi disk. Flouroquinolones adalah antibiotik
yang paling sering diresepkan (94%). Di antara flouroquinolones, Moksifloksasin adalah obat yang paling sering
diresepkan (52%). Staphylococcus aureus memiliki tingkat kekambuhan tertinggi (92,3%) diikuti oleh P. aeruginosa
pada (4%) yang diisolasi dari swab. Moxifloksasin memiliki zona hambat tertinggi diikuti oleh ciprofloksasin dan
ofloksasin pada isolasi S.aureus. Antibiotik dengan benar diresepkan pada kasus Konjunctivitiso karena bakteri dan
antibiotik hanya diresepkan pada kasus dengan dugaan infeksi virus untuk mencegah infeksi sekunder.

Kata kunci: Pola resep, Antibiotik, Konjungtivitis

PENGANTAR organisme penyebab dengan kultur bakteri atau

Konjungtivitis didefinisikan sebagai melakukan tes kerentanan antibiotik dari organisme
peradangan pada konjungtiva. Hal ini biasanya yang diidentifikasi. Namun dalam praktek sehari hari
disebabkan oleh infeksi bakteri, virus atau klamidia. kultur bakteri tidak praktis karena lama dalam
Mikroorganisme bakteri yang paling sering termasuk mendiagnosa dan pasien membutuhkan pertolongan
Staphylococcus aureus, Streptococcus pneumonia, cepat untuk ketidaknyamanan pada mata. Oleh
Hemophilusaegyptius, Cornybacterium difteri, karena itu antibiotik berspektrum luas dengan rute
Neisseria gonorrhoeae, Moraxella lacunata, dan lain- oral yang di resepkan. Antibiotik topikal yang sering di
lain. Infeksi konjungtivitis biasanya di sertai hiperemi gunakan pada konjungtivitis infeksi adalah
dengan berbagai derajat, sekret mukopurulen, gatal, fluoroquinolones (misalnya, ciprofloksasin,
iritasi, sensasi benda asing, anyaman bulu mata dan levofloksasin, ofloksasin, moksifloksasin),
1,2
pengerasan kulit kelopak mata. Umumnya, kondisi aminoglikosida (misalnya, gentamisin dan tobramisiin)
ini biasanya sembuh sendiri dan jinak namun menurut kombinasi berbasis polimiksin (misalnya, polimiksin B
dokter perjalanan infeksi dapat dipersingkat dengan sulfat dan trimetoprim), azitromisin dan
6,7
menggunakan agen antibiotik. Penggunaan antibiotik kloramfenikol.
tidak hanya mempercepat penyembuhan pasien, tapi
juga membunuh bakteri dengan cepat dan
3,6
mengurangi resiko penyebaran. Dokter sering
memberikan resep antibotik sebelum mengidentifikasi

1
600 SUPRITHA et al., Biomed. & Pharmacol. J., Vol. 9(2), 599-604 (2016)

Indiscriminate use of antibiotics has been language, Tamil, and English based on the
linked with the development of antibiotic resistant preference of the patient prior to collecting the swab
strains of bacteria.3,4,5The therapeutic efficacy of the for the interventional procedure.
drug can be increased by studying the utilization
pattern of drugs and this will help to reduce the Collection of swab2, 10
occurrence of antibiotic resistant strains of Conjunctival swab was collected from the
bacteria.8,9 By recording the prescription patterns affected eye with sterile cotton tipped applicator
and performing the antibiotic sensitivity test with wiped twice across the conjunctiva of lower fornix
the prescribed antibiotics, the susceptibility or from the temporal to nasal side. The swab was put
resistance of the pathogens to the prescribed into a transport medium (Stuart’s transport medium)
antibiotics can be identified. In addition the and labeled. Then they were taken to the laboratory
susceptibility of the pathogen to the commonly within two hours of collection. Upon arrival, the
prescribed antibiotics is performed too. This sample was inoculated onto MacConkey agar,
comparison will help optimize the prescription Blood agar and Chocolate agar.
pattern.
Preparation of Medium2, 10
MATERIALS AND METHODS All the media plates for culture were
prepared at the laboratory. The powdered medium
This study was a prospective study was mixed well with water and heated with frequent
conducted in the Department of Pharmacology in agitation to dissolve the agar. Sterilization of the
association with the Department of Ophthalmology media was done in an autoclave at 121 degree
and Department of Microbiology, SRM Medical celsiusfor about 15 minutes. The media was then
College, Hospital& Research Centre allowed to cool at 45 degree celsiusat which
(SRMCH&RC), Tamil Nadu. The study was carried temperature it still remains molten. The molten
out over a period of three months from July, 2013 to media was then poured into sterile petri dishes
September, 2013 and was approved by the (20ml in each dish) and was left undisturbed until
Institutional Ethical Committee (467/IEC/2013). The the agar solidified. Blood agar was prepared by
study population comprised of a sample size of 50 mixing with 5% sheep blood before pouring into
subjects diagnosed with infectious conjunctivitis. the plates. Chocolate agar was prepared by heating
The prescriptions were collected and evaluated Blood agar to 70 degree Celsius till the chocolate
accordingly for the prescribing pattern. colour is observed.

The inclusion criteria for selecting the Inoculation of Medium10

patients were beingof any age and sex,diagnosed The swabs were inoculated onto
with infectious conjunctivitis and prescribed some MacConkey, Blood agar and Chocolate agar plates
antibiotics. The exclusion criteria were those by using the streaking method with a sterile
patients who were prescribed outside the hospital inoculation loop. The plates were then incubated
and the patients who had previously been for 24 hours at 37 degree Celsius.
undergoing antibiotic treatment (local or
systemic).According to the inclusion and exclusion Analysis of Culture
criteria, the prescription were selected and The cultures were analysed for growth.In
evaluated for the prescribing pattern of antibiotics cases of positive culture, the organism was
for conjunctivitis. The demographic profiles of the identified based on gram staining and by using
patients were analysed. The different prescription routine standard biochemical tests like Coagulase
indicators like average number of drugs per test, Catalase test and Oxidase test.
prescription, average number of antibiotics
prescribed, percentage of fixed dose combination, Antibiotic Sensitivity test
drugs prescribed from National List of Essential The antibiotic sensitivity tests were done
Medicines of India (NLEM, 2011).A patient consent by disc diffusion method.The inoculum was streaked
form was presented to the subjectin the regional evenly over the entire surface of the media in the
 Penyalahgunaan antibiotik telah dikaitkan intervensi pasien di mintai persetujuan dengan di
dengan berkembangnya strain bakteri yang resisten berikan formulir persetujuan dengan bahasa
3,4,5
terhadap antibiotik. Khasiat terapi obat dapat setempat, dan bahasa inggris.
2,10
ditingkatkan dengan mempelajari pola penggunanaan PENGAMBILAN SWAB
obat dan hal ini dapat membantu mengurangi Swab konjungtiva diambil dari mata yang
terjadinya strain bakteri yang resisten terhadap terkena dengan dua kali usapan sampai bagian
8,9
antibiotik yang di resepkan. Dengan merekam pola bawah fornix konjungtiva dari arah temporal ke nasal
resep dan melakukan tes sensitivitas antibiotik dengan menggunakan ujung kapas steril. Swab lalu
terhadap antibiotik yang diresepkan, kerentanan atau dimasukkan ke dalam media transport (media
resistensi patogen terhadap antibiotik yang transport Stuart) dan diberi label. Kemudian dibawa
diresepkan dapat diidentifikasi. Selain itu kerentanan ke laboratorium dalam waktu dua jam setelah
patogen terhadap antibiotik yang umum diresepkan pengambilan. Setelah sampai, sampel diinokulasi ke
juga dilakukan. Perbandingan ini akan membantu agar MacConkey, agar darah dan agar coklat.
mengoptimalkan pola resep. PERSIAPAN MEDIA2,10
METODE DAN BAHAN Semua media untuk kultur disiapkan di
Penelitian ini adalah penelitian prospektif laboratorium. Media bubuk dicampur dengan air dan
yang dilakukan di Departemen Farmakologi dipanaskan dengan beberapa kali agitasi untuk
bekerjasama dengan Departemen Ophthalmologi dan mencampur agar. Sterilissi media dilakukan dalam
Departemen Mikrobiologi, rumah sakit pendidikan autoklaf 121 derajat selsius selama 15 menit.
dokter dan Pusat Penelitian SRM (SRMCH & RC), Kemudian media dibiarkan dingin pada suhu 45
Tamil Nadu. Penelitian ini dilakukan selama tiga bulan deraja selsius dimana suhu masih tetap cair. Media
dari Juli 2013 sampai September 2013 dan telah cair kemudian dituangkan kedalam cawan petri steril
disetujui oleh Komite Etik Kelembagaan (20 ml setiap cawan) dan dibiarkan tidak terganggun
(467/IEC/2013). Populasi penelitian terdiri dari 50 sampai agar menjadi padat. Agar darah disiapkan
sampel subyek yang didiagnosis konjungtivitis infeksi. dengan mencampur 5% darah domba sebelum di
Resep dikumpulkan dan pola resepnya langsung tuangkan kedalam cawan. Agar coklat di siapkan
dievaluasi. dengan memanaskan agar darah sampai 70 deraja
Kriteria inklusi untuk memilih pasien dari selsius di amati sampai warna coklat terlihat.
10
berbagai usia dan jenis kelamin, yang didiagnosis MEDIA INOKULASI
konjungtivitis infeksi dan yang mendapat resep Swab diinokulasikan ke dalam agar
antibiotik. Kriteria eksklusi adalah pasien mendapat MacConkey, agar darah dan agar coklat dengan
resep dari luar rumah sakit dan pasien yang menggunakan metode goresan inokulasi loop steril.
sebelumnya telah menjalani pengobatan antibiotik Cawan kemudian di inokulasi selama 24 jam pada
(lokal atau sistemik) .Menurut kriteria inklusi dan suhu 37 derajat selsius.
eksklusi, resep dipilih dan dievaluasi pola resep ANALISA KULTUR
antibiotik untuk konjungtivitis. Profil demografis dari Kultur dianalisa pertumbuhannya. Jika kultur
pasien juga dianalisa. Indikator yang berbeda dari positif, organisme diidentifikasi berdasarkan
resep seperti rata-rata jumlah obat per resep, rata- pewarnaan gram dan pemeriksaan standar biokimia
rata jumlah antibiotik yang diresepkan, persentase seperti tes koagulase, tes katalase dan tes oksidase.
kombinasi dosis tetap, obat yang diresepkan dari TES KEPEKAAN ANTIBIOTIK
Daftar Obat Esensial National India (DOEN, 2011). Tes kepekaan antibiotik dilakukan dengan
sebelum mengumpulkan swab untuk prosedur metode cakram difusi. Inokulum digoreskan hampir

2
 SUPRITHA et al., Biomed. & Pharmacol. J., Vol. 9(2), 599-604 (2016) 601

petridish with a sterile cotton swab. Disc RESULTS

impregnated with corresponding prescribed
antibiotic solution and other broad spectrum During the study period, the prescriptions
antibiotic solutions was placed in the petri dish of the patients were analysed for demographic
containing agar. Inhibition of growth around 5mm profile. The average age of the patients was 29.04
around the antibiotic disc indicated sensitivity to ± 15.79 years. The number of female patients was
that particular antibiotic and total absence of such 42% and male patients were 58%. About 14% of
zone indicated resistance.After identifying and the patients were in pediatric age group and 8%
assessing the sensitivity, a comparison was done were in geriatric age group. The average number
with the sensitivity of the causative organism to the of drugs prescribed was 1.54 ±0.57. The most
prescribed antibiotic and the other broad spectrum commonly prescribed formulation was eye drops
antibiotics. (100%). Accompanying the eye drops, ointment
preparation of antibiotics were prescribed in 14%
Statistical analysis of cases. Flouroquinolones were the most
The data for prescription was collected in commonly prescribed antibiotics (94%). Only 6%
the predesigned proforma and was expressed as of cases, aminoglycoside was prescribed. Among
mean ± SD. The descriptive tables were generated the flouroquinolones , Moxifloxacin (52%),
and appropriate proportions were calculated. Ofloxacin (26%) and Ciprofloxacin (16%) were

Table 1: Characterization and identification of bacterial isolates

Morphology Gram Catalase Coagulase Oxidase Probable identity

stain of the isolates

Cocci in clusters + + - + Staphylococcus aureus

Rods in long chain and clusters - - + - Pseudomonas aeruginosa

Table 2: Zone of inhibition of different drugs against isolated microorganisms

Microorganism Ciprofloxacin Ofloxacin Moxifloxacin Amikacin Tobramycin

Staphylococcus aureus 16 mm 13 mm 18 mm 9 mm 11 mm
Pseudomonas aeruginosa 16 mm 12mm 5mm 13 mm 15 mm

Fig. 1(a): Fig. 1(b):

diseluruh permukaan cakram media petri dengan HASIL
swab kapas steril. cakram dicampurkan dengan Selama masa penelitian, resep dari pasien dianalisis
larutan antibiotik yang diresepkan dan larutan untuk profil demografi. Rata-rata usia pasien adalah
antibiotik spekterum luas lainnya ditempatkan dalam 29,04 15,79 tahun. Jumlah pasien wanita adalah
cawan petri yang berisi agar. Pertumbuhan zona 42% dan pasien laki-laki sebanyak 58%. Sekitar 14%
hambat 5 mm di sekitar cakram antibiotik dari pasien berada dalam kelompok usia muda dan
menunjukkan kepekaan terhadap antibiotik dan jika 8% berada dalam kelompk usia muda. Rata-rata
tidak ada zona hambat maka resisten. Setelah jumlah obat yang diresepkan adalah 1,54 0,57.
mengidentifikasi dan menilai sensitivitas, formula yang paling sering diresepkan adalah tetes
perbandingan dilakukan dengan organisme penyebab mata (100%). Pada 14% kasus diresepkan salep
yang sensitif terhadap antiobiotik yang diresepkan antibiotik disertai tetes mata. Flouroquinolon adalah
dan antibiotik spektrum luas lainnya. antibiotik yang paling sering diresepkan (94%). Hanya
ANALISIS STATISTIK 6% dari kasus, yang di resepkan aminoglikosida.
Data untuk resep dikumpulkan dalam predesain selain flouroquinolon, Moksifloksasin (52%), Oflosasin
proforma dan dinyakatan dalam bentuk nilai +/- dalam (26%) dan Ciprofloksasin (16%) juga
standar deviasi. Hasilnya dideskripsikan dalam
bentuk tabel dan di hitung dalam jumlah yang tepat.

Tabel 1: Karakterisasi dan identifikasi bakteri yang di isolasi

Morfologi Gram Katalase Koagulase Oksidase Kemungkinan bakteri yang
diidentifikasi
Cocci di cluster + + - + Staphylococcus aureus

Batang di rantai panjang dan - - + - Pseudomonas aeruginosa

cluster

Tabel 2: Zona hambat obat lain terhadap mikroorganisme yang di isolasi

Mikroorganisme ciprofloksasin ofloksasin moksifloksasin amikasin Tobramisin

Staphylococcus aureus 16 mm 13 mm 18 mm 9 mm 11 mm

Pseudomonas aeruginosa 16 mm 12 mm 5 mm 13 mm 15 mm

Gambar a. Gambar b.

3
602 SUPRITHA et al., Biomed. & Pharmacol. J., Vol. 9(2), 599-604 (2016)

prescribed. Tobramycin was the only The bacterial isolates from the conjuctival
aminoglycoside which was prescribed in 6% of swabs were of staphylococcus aureus and
patients. Out of the 50 prescriptions the antibiotic Pseudomonas origin based on the gram staining
with proper dosage form, frequency and duration and catalase, coagulase and oxidase tests
mentioned were 100%, 100% and 38% (Table1). Staphylococcus aureus was isolated in
respectively. The drugs were prescribed in generic 92.3% of cases and Pseudomonas aeruginosa in
names in 24% and with brand names in 76% cases. 4% cases (Figure 1a,1b,1c). Moxifloxacin has the
In only 42% of cases the antibiotics were prescribed highest zone of inhibition followed by ciprofloxacin
from the National List of Essential Medicines of India and ofloxacin in S.aureusisolates and Ciprofloxacin
(NLEM, 2011). Carboxymethylcellulose sodium followed by Tobramycin and amikacin in
was prescribed in 40% of cases as a concomitant P.aeruginosa isolates (Table 2, Figure 2).
drug in conjunctivitis. The common prescription
writing errors were minimum. There was no
evidence of polypharmacy.

Fig. 1(c): Fig. 2:

DISCUSSION flouroquinolones which correlates with the findings

of Yashmeen et al. 12 . The fourth generation
Bacterial conjunctivitis is mostly a self- flouroquinolones like Moxifloxacin was the highest
limiting disorder. However some studies have prescribed antimicrobial among all. A broad
shown that treatment with an antibiotic associated spectrum of bacteria (both gram positive and gram
with significant better rates of early clinical negative) like Staphylococcus aureus,
remission. In our study, it was observed that Staphylococcus epidermidis , Streptococcus
antimicrobials are invariably prescribed in pneumonia , Haemophilus influenza, Klebsiella
conjunctivitis patients. But only about half of the spp., Moraxella catarrhalis are susceptible to
conjuctival swabs collected showed positive Moxifloxacin. Only in few cases aminoglycoside like
bacterial culture (52%) which means that the Tobramycin was prescribed. The antibiotics were
antimicrobials are commonly prescribed to all the prescribed with proper dosage form, frequency and
patients irrespective of the type of origin of infection. duration. Most of the drugs were prescribed by their
Prescribing of antibiotics was rightly indicated brand names. This results is similar to the findings
according to the diagnosis except for viral of Yashmeen et al .12
conjcutivitis whose treatment is nonspecific, but in
our study we found that the antibiotics were In our study, Staphylococcus aureus was
prescribed in about 48% of negative culture cases the most common bacteria isolated from the culture.
probably to prevent secondary infection.9 The most Studies have shown that Staphylococcus aureus
common antimicrobials prescribed were is the most frequent cause of bacterial conjunctivitis
di resepkan. tobramisin adalah satu- nama dagang. Dari 42% kasus antibiotik yang
satunyaaminoglikosida yang diresepkan pada 6% diresepkan berasal dari Daftar Obat Esensial
pasien. Dari 50 resep antibiotik dengan dosis yang Nasional India (DOEN, 2011). karboksimetilselulosa
tepat, frekuensi dan durasi yang disebutkan masing- diresepkan dalam 40% kasus sebagai obat tambahan
masing 100%, 100% dan 38% . Obat generik yang konjungtivitis. Umumnya kesalahan penulisan resep
diresepkan sebanyak 24% dan 76% obat dengan sangat minim. Tidak ada bukti dari polifarmasi.

Gambar c. Gambar d.

DISKUSI banyak diresepkan dari semua. spektrum luas dari

Konjungtivitis bakteri adalah gangguan selflimiting bakteri (baik gram positif dan gram negatif) seperti
yang sering terjadi. Namun beberapa penelitian telah Staphylococcus aureus, Staphylococcus epidermidis,
menunjukkan bahwa pengobatan dengan antibiotik Streptococcus pneumonia, Haemophilus influenza,
terkait dengan tingkat perbaikan yang signifikan dari Klebsiella spp., Moraxella catarrhalis rentan terhadap
gejala awal. Dalam penelitian kami, diamati Moksifloksasin. Hanya dalam beberapa kasus
antimikroba yang sering diresepkan pada pasien aminoglikosida seperti tobramisin diresepkan.
konjungtivitis. Tapi hanya sekitar setengah dari swab Antibiotik yang diresepkan dalam dosis yang tepat,
konjungtiva yang dikumpulkan menunjukkan kultur frekuensi dan durasi. Sebagian besar obat yang
bakteri positif (52%) yang berarti bahwa antimikroba diresepkan dengan nama dagang. Hasil ini mirip
yang umumnya diresepkan untuk semua pasien dengan temuan dari Yashmeen et al.12
terlepas dari penyebab infeksi. Resep antibiotik yang Dalam penelitian kami, Staphylococcus aureus
benar ditunjukkan sesuai dengan diagnosis kecuali adalah bakteri yang umumnya diisolasi dari kultur.
untuk conjungtivitis virus yang pengobatannya tidak Penelitian menunjukan bahwa Staphylococcus aureus
spesifik, tetapi dalam penelitian kami, kami adalah penyebab tersering dari konjungtivitis bakteri
menemukan bahwa antibiotik yang diresepkan di diseluruh dunia.13,14
sekitar 48% dari kasus kultur negatif mungkin untuk Bakteri gram negatif seperti Pseudomonas
9
mencegah infeksi sekunder. antimikroba yang paling aeruginosa diisolasi pada beberapa kasus (4%).
umum diresepkan adalah flouroquinolon yang Tes kepekaan antibiotik menunjukan bahwa
12
berkorelasi dengan temuan Yashmeen et al. moksifloksasin memilki sensitivitas tertinggi dari
Generasi keempat flouroquinolon seperti beberapa antibiotik dalam kasus dimana
Moksifloksasin adalah antimikroba yang paling staphylococcus aureus diisolasi diikuti ciprofloksasin

4
 SUPRITHA et al., Biomed. & Pharmacol. J., Vol. 9(2), 599-604 (2016) 603

worldwide. 13,14The gram negative bacteria like was no evidence of polypharmacy. The study has
Pseudomonas aeruginosa was isolated only in few also shown that the most common causative
cases (4%). organism in bacterial conjunctivitis is
Staphylococcus aureus. The bacteria isolated in this
The antibiotic sensitivity tests revealed that study were susceptible to the commonly prescribed
Moxifloxacin has the highest sensitivity over other broad spectrum antibiotics like fluoroquinolones
antibiotics in cases where Staphylococcus aureus (Moxifloxacin, Ciprofloxacin, Ofloxacin) and
has been isolated followed by Ciprofloxacin and aminoglycosides (Tobramycin and Amikacin).
Ofloxacin. In gram negative isolates (Pseudomonas Moxifloxacin was the most effective in isolates of
aeruginosa), Ciprofloxacin was found to be most Staphylococcus aureus followed by Ciprofloxacin
sensitive followed by Tobramycin and Amikacin and Ofloxacin whereas in isolates of Pseudomonas
(aminoglycoside). Our study results indicate that aeroginosa Ciprofloxacin was most effective
newer generation fluoroquinolones is the preferred followed by Tobramycin and Amikacin. The most
antibiotics than the old generation flouroquinolones commonly prescribed antibiotic is Moxifloxacin, a
due to its broader antibiotic susceptibility.15In all of newer generation fluoroquinolones. Antibiotics
the positive culture cases, the bacterial isolates were correctly prescribed in 52% of cases. But in
were susceptible to the prescribed antibiotic which 48% of culture negative cases which could be of
was evident through the Antibiotic Sensitivity Tests. viral origin, antibiotics were assumed to be
Hence, the antibiotics are correctly prescribed in prescribed to prevent secondary infections.
most cases (52%). In the other 48%, antibiotics were
prescribed in culture negative cases, which may ACKNOWLEDGMENTS
be of viral origin.
We sincerely acknowledge the Indian
CONCLUSION Council of Medical Research for funding this STS
project. We are thankful to the dept of Opthalmology
The study has shown that the common and dept of Microbiology, SRM Medical College
prescription writing errors were minimal and there Hospital & Research Centre for their contribution.

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4. BertinoJr, Joseph S. “Impact of antibiotic of clinical pharmacology 2001; 51(3): 267-
resistance in the management of ocular 269.
infections: the role of current and future 9. Topno, Isabella, et al. “Antibiotic prescribing
antibiotics.” Clinical ophthalmology pattern in ophthalmology outpatient
(Auckland, NZ) 2009; 3: 507. department in a ter tiary care hospital.”
5. Sharma S.; Antibiotic resistance in ocular Journal of Pharmacology &
bacterial pathogens. Indian J Med Microbiol Pharmacotherapeutics 2012; 3(2): 190.
2011; 29: 218-22 10. Faustina, Idu, and Stella Odjimogho.
dan ofloksasin. Pada isolasi gram negatif combinations of signs and symptoms.” BMJ
(pseudomonas aeruginosa), ciprofloksasin ditemukan 2004; 329.7459: 206-210.
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amikasin (aminoglikosida). Penelitian kami conjunctivitis.”Actaophthalmologica 2008;
menunjukan hasil bahwa generasi terbaru 86(1): 5-17.
fluoroquinolon lebih dipilih dari pada generasi lama 4. BertinoJr, Joseph S. “Impact of antibiotic
fluoroquinolon karena kerentanan antibiotik yang resistance in the management of ocular
15
luas. pada semua kasus dengan hasil kultur positif, infections: the role of current and future
bakteri yang diisolasi rentan terhadap antibiotik yang antibiotics.” Clinical ophthalmology
diresepkan bukti ini didapatkan melalui tes kepekaan (Auckland, NZ) 2009; 3: 507.
antibiotik. Meskipun, antibiotik yang diresepkan benar 5. Sharma S.; Antibiotic resistance in ocular
pada kebanyakan kasus (52%), pada 48% lainya, bacterial pathogens. Indian J Med Microbiol
antibiotik yang diresepkan pada kasus kultur negatif, 2011; 29: 218-22.
mungkin penyebabnya virus. 6. Rose P.; “Management strategies for acute
KESIMPULAN infective conjunctivitis in primary care: a
Penelitian telah menunjukkan bahwa kesalahan systematic review”. Expert Opin
penulisan resep umunya minim dan tidak ada bukti Pharmacother. 2007; 8(12): 1903-1921.
dari polifarmasi. Penelitian ini juga menunjukkan 7. Bartlett JD, Jaanus S.; Clinical Ocular
bahwa organisme penyebab tersering konjungtivitis Pharmacology. St. Louis, MO: Butterworth
bakteri adalah Staphylococcus aureus. Bakteri yang Heinemann Elsevier; 2008.
diisolasi dalam penelitian ini rentan terhadap antibiotik 8. Biswas, Nihar R., et al. “Patterns of
spektrum luas yang umum diresepkan seperti prescription and drug use in ophthalmology
fluoroquinolones (Moksifloksasin, Ciprofloksasin, in a tertiary hospital in Delhi.” British journal
Ofloksasin) dan aminoglikosida (tobramisin dan of clinical pharmacology 2001; 51(3): 267-
Amikasin). Moksifloksasin paling efektif pada isolasi 269.
Staphylococcus aureus diikuti oleh Ciprofloksasin dan 9. Topno, Isabella, et al. “Antibiotic prescribing
Oflokasasin sedangkan pada isolasi Pseudomonas pattern in ophthalmology outpatient
aeroginosa, Ciprofloksasin paling efektif diikuti oleh department in a tertiary care hospital.”
tobramisin dan Amikasin. antibiotik yang paling umum Journal of Pharmacology &
diresepkan adalah Moksifloksasin, generasi. terbaru Pharmacotherapeutics 2012; 3(2): 190.
fluoroquinolones. Antibioti dengan benar diresepkan 10. Faustina, Idu, and Stella Odjimogho
pada 52% kasus. Namun dalam 48% dari kasus “Susceptibility of conjunctival bacterial
kultur negatif yang penyebabnya virus,antibiotik pathogens to fluoroquinolones.A
hanya diresepkan untuk mencegah infeksi sekunder. comparative study of ciprofloxacin,
norfloxacin and ofloxacin.”Online Journal of
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