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Eye Infections

Author/s: 
Marlene L Durand, Miriam B Barshak, Lucia Sobrin

Eye infections are an important cause of vision loss worldwide. Patients with these infections are commonly seen by primary care providers, internists, emergency medicine specialists, hospitalists, and ophthalmologists. Each year in the United States alone, conjunctivitis accounts for more than 550,000 visits to emergency departments1 and many more visits to outpatient offices, keratitis is diagnosed at more than 1 million office and emergency department visits,2 exogenous endophthalmitis complicates up to 0.1% of the more than 7 million cataract surgeries and intravitreal injections performed,3-5 and thousands of patients are admitted to general hospitals to treat vision-threatening eye infections such as endogenous endophthalmitis and infectious uveitis. This review summarizes the epidemiology, diagnosis, and treatment of eye infections. Figure 1 illustrates eye anatomy as it relates to eye infections. Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org, summarizes the microbiologic features, clinical characteristics, and treatment of these infections.

Keywords 
eye infection eyes Ophthalmologists Ophthalmology

Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Author/s: 
Lee, Rachael A., Centor, Robert M., Humphrey, Linda L., Jokela, Janet A., Andrews, Rebecca, Qaseem, Amir

Description: Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these infections.

Methods: The authors conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed bronchitis with COPD exacerbations, CAP, UTIs, and cellulitis. This article is based on the best available evidence but was not a formal systematic review. Guidance was prioritized to the highest available level of synthesized evidence.

Best practice advice 1: Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).

Best practice advice 2: Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.

Best practice advice 3: In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP-SMZ (14 days) based on antibiotic susceptibility.

Best practice advice 4: In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.

Keywords 
pneumonia Cellulitis bacterial infections Anti-Bacterial Agents Best practive
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