Bacterial Antibiotic Resistance Is an Ongoing Issue1

The Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) Surveillance Study found that concurrent antibiotic resistance rates were highest among methicillin-resistant isolates.1 The ARMOR study is the largest and only ongoing study that monitors resistance trends among ocular pathogens of concern.*

Full population1

Pediatric subgroup2

76%

49%

Methicillin-resistant Staphylococcus aureus (MRSA) isolates
showed multidrug resistance to at least 3 additional antibiotic classes.

Full population1

74%

Pediatric subgroup2

70%

Methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolates
showed multidrug resistance to at least 3 additional antibiotic classes.

Clinical significance of these in vitro data has not been established.

*Gram-positive and Gram-negative pathogens monitored were:

Ocular pathogen: Staphylococcus aureus

Staphylococcus
aureus

Ocular pathogen: Coagulase-negative staphylococci (CoNS, including S. epidermidis)

Coagulase-negative staphylococci (CoNS, incl. S. epidermidis)

Ocular pathogen: Streptococcus pneumoniae

Streptococcus
pneumoniae

Ocular pathogen: Haemophilus influenzae

Haemophilus
influenzae

Ocular pathogen: Pseudomonas aeruginosa

Pseudomonas
aeruginosa

Full Population Study Design: Isolates were collected from 87 ocular centers, community hospitals, and university hospitals from January 1, 2009, through December 31, 2016. A total of 4,829 ocular isolates were collected (1,695 S. aureus, 1,475 CoNS, 474 S. pneumoniae, 586 H. influenzae, and 599 P. aeruginosa) and, of these, the anatomical source (conjunctiva, cornea, aqueous humor, or vitreous humor) was known for 2,427 isolates. Minimum inhibitory concentrations (MICs) were determined for drugs from more than 10 antibiotic classes, and isolates were classified as susceptible or resistant based on available systemic breakpoints.1,3

The pediatric subgroup (≤17 years of age) in the ARMOR study included 995 conjunctival isolates collected from 67 sites over 8 years.2

  • The majority of H. influenzae, S. aureus, CoNS and S. pneumoniae isolates were obtained from pediatric patients ≤3 years of age
  • About half of P. aeruginosa isolates were obtained from adolescent patients 11–17 years of age

Safety and effectiveness in infants below one year of age have not been established

Antibiotic Resistance Is a Nationwide Concern3

From numerous samples of pathogens provided from the US, investigators evaluated resistance rates across 4 national regions

Antibiotic resistance rates across four national regions

Mean percentage resistance rates shown for each pathogen across 4 regions.3

WEST

Staphylococcus aureus ... 16.8%

MRSA ... 24.4%

CoNS ... 26.0%

MRCoNS ... 44.1%

Streptococcus pneumoniae ... 7.6%

Haemophilus influenzae ... 0.3%

Pseudomonas aeruginosa ... 2.9%

MIDWEST

Staphylococcus aureus ... 23.4%

MRSA ... 40.1%

CoNS ... 27.5%

MRCoNS ... 53.8%

Streptococcus pneumoniae ... 14.5%

Haemophilus influenzae ... 0.8%

Pseudomonas aeruginosa ... 8.5%

SOUTH

Staphylococcus aureus ... 28.1%

MRSA ... 48.5%

CoNS ... 29.6%

MRCoNS ... 51.1%

Streptococcus pneumoniae ... 11.9%

Haemophilus influenzae ... 0.0%

Pseudomonas aeruginosa ... 3.6%

NORTHEAST

Staphylococcus aureus ... 23.0%

MRSA ... 36.0%

CoNS ... 27.0%

MRCoNS ... 44.3%

Streptococcus pneumoniae ... 9.9%

Haemophilus influenzae ... 0.6%

Pseudomonas aeruginosa ... 5.4%

P values for the distribution of pathogens listed above grouped by geographical region: P<0.001 for S. aureus and MRSA, P>0.05 for CoNS, P<0.006 for MRCoNS, P<0.001 for S. pneumoniae, P>0.05 for H. influenzae, and P=0.005 for P. aeruginosa. P values for MRSA and MRCoNS were calculated using the χ2 test while ANOVA was used for the other isolate types.3

For the analysis by geography, isolates were categorized into 4 regions based on state of origin, including West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming), Midwest (Iowa, Illinois, Indiana, Kansas, Kentucky, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, South Dakota, and Wisconsin), South (Alabama, Arkansas, Florida, Georgia, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia), and Northeast (Connecticut, Delaware, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont).3

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See Resistance Data

Learn about the in vitro inhibitory activity of besifloxacin against ocular bacterial pathogens.

 
 
Indication

BESIVANCE® (besifloxacin ophthalmic suspension) 0.6% is a quinolone antimicrobial indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following bacteria: Aerococcus viridans*, CDC coryneform group G, Corynebacterium pseudodiphtheriticum*, Corynebacterium striatum*, Haemophilus influenzae, Moraxella catarrhalis*, Moraxella lacunata*, Pseudomonas aeruginosa*, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis*, Staphylococcus lugdunensis*, Staphylococcus warneri*, Streptococcus mitis group, Streptococcus oralis, Streptococcus pneumoniae, Streptococcus salivarius*

*Efficacy for this organism was studied in fewer than 10 infections.

Important Safety Information
  • BESIVANCE is not for injection into the eye.
  • As with other anti-infectives, prolonged use of BESIVANCE may result in overgrowth of non-susceptible organisms, including fungi. If super-infection occurs, discontinue use and institute alternative therapy.
  • Patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis or during the course of therapy with BESIVANCE.
  • The most common adverse event reported in approximately 2% of patients treated with BESIVANCE was conjunctival redness. Other adverse events reported in patients receiving BESIVANCE occurring in approximately 1-2% of patients included: blurred vision, eye pain, eye irritation, eye pruritus and headache.
  • Safety and effectiveness in infants below one year of age have not been established.

Click here for full Prescribing Information for BESIVANCE.

References: 1. Thomas RK, Melton R, and Asbell PA. Antibiotic resistance among ocular pathogens: current trends from the ARMOR surveillance study (2009-2016). Clin Optom. 2019;11:15-26. 2. Alter SJ, Sanfilippo CM, Asbell PA, DeCory HH. Antibiotic resistance among pediatric-sourced ocular pathogens: 8-year findings from the ARMOR surveillance study. Pediatr Infect Dis J. 2018; 28:138-145. 3. Asbell PA, Pandit RT, Sanfillipo CM. Antibiotic resistance rates by geographic region among ocular pathogens collected during the ARMOR surveillance study. Ophthalmol Ther. 2018;7:417-429.

 
Indication

BESIVANCE® (besifloxacin ophthalmic suspension) 0.6% is a quinolone antimicrobial indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following bacteria: Aerococcus viridans*, CDC coryneform group G, Corynebacterium pseudodiphtheriticum*, Corynebacterium striatum*, Haemophilus influenzae, Moraxella catarrhalis*, Moraxella lacunata*, Pseudomonas aeruginosa*, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis*, Staphylococcus lugdunensis*, Staphylococcus warneri*, Streptococcus mitis group, Streptococcus oralis, Streptococcus pneumoniae, Streptococcus salivarius*

*Efficacy for this organism was studied in fewer than 10 infections.

Important Safety Information
  • BESIVANCE is not for injection into the eye.
  • As with other anti-infectives, prolonged use of BESIVANCE may result in overgrowth of non-susceptible organisms, including fungi. If super-infection occurs, discontinue use and institute alternative therapy.
  • Patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis or during the course of therapy with BESIVANCE.
  • The most common adverse event reported in approximately 2% of patients treated with BESIVANCE was conjunctival redness. Other adverse events reported in patients receiving BESIVANCE occurring in approximately 1-2% of patients included: blurred vision, eye pain, eye irritation, eye pruritus and headache.
  • Safety and effectiveness in infants below one year of age have not been established.

Click here for full Prescribing Information for BESIVANCE.

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