Fusidic acid viscous eyedrops – an evaluation of pharmacodynamics, pharmacokinetics and clinical use for UK optometrists

Abstract

Recent changes in UK law have allowed UK-based optometrists to sell and supply fusidic acid viscous eyedrops, providing it is in the course of their professional activity and in an emergency. Alternatively, the optometrist may access fusidic acid viscous eyedrops, for a named patient, using a written order supplied to a pharmacy. This review provides details of the legal background to these changes, examines the common causes of a bacterial conjunctivitis, examines the mechanism of action of this narrow spectrum antibiotic as a bacteriostatic agent, reviews the susceptibility of common ocular isolates of bacteria to the drug and presents details of the expected pharmacokinetics of the viscous eyedrops. From this perspective, a systematic review is provided of the clinical studies which have investigated the use of fusidic acid viscous eyedrops and their outcome. The indicated use is generally for the treatment of bacterial conjunctivitis and/or blepharoconjunctivitis, especially that caused by Staphylococcus, but not Streptococcus or Haemophilus sp. (more likely associated with concurrent nasopharyngeal infections). The usual regimen for use is twice daily for 5-10 days, depending on severity, and can initially be used more intensively (four times per day). It may also be used for the management of corneal and conjunctival abrasions and foreign body injuries, or some cases of chronic blepharitis.

Equine ulcerative keratitis in Belgium: Associated bacterial isolates and in vitro antimicrobial resistance in 200 eyes

“…Fusidic acid is a narrow spectrum antibiotic that is useful for the treatment of ocular bacterial infections caused by Staphylococcus, but not Streptococcus. 29 As expected, more than 80% of the Streptococcus spp. in our study were resistant whereas only 6.1% of the Staphylococcus spp.…”

A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role

“…Chloramphenicol has been available to optometrists for almost 20 years for use in the course of their professional practice and for supply to patients (directly or via a ‘signed’ order). Fusidic acid has only recently (April 2005) been added to the list of drugs that optometrists can use and supply (Doughty and Dutton, 2006). The survey found that neither antibiotic was commonly supplied: chloramphenicol was supplied frequently by 12% and fusidic acid by only 2% of respondents.…”

Systematic reviews of optometric interventions

“…Systematic reviews have appeared rarely in the optometric literature, although some are starting to appear in the Cochrane database (http://www.thecochranelibrary.com), which is the largest source of systematic reviews and named after Archie Cochrane (1909–1988), a Scottish physician and epidemiologist who is generally attributed with starting the evidence‐based approach to health care. A PubMed March 3rd 2012 search of the three ISI‐listed optometric journals, Ophthalmic & Physiological Optics , Optometry & Vision Science and Clinical & Experimental Optometry for ‘systematic reviews’ published in the last 10 years identified only four such manuscripts 1–4 . Although recent reviews of optometric treatments for myopia have been published, 5 a search of PubMed using the keywords ‘systematic review’ and ‘myopia’ found no systematic review of the optometric treatment of myopia.…”