Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones.

The three topical ophthalmic fluoroquinolones recently introduced into the U.S. market--levofloxacin, gatifloxacin, and moxifloxacin--offer several advantages over the previously available fluoroquinolones (norfloxacin 0.3%, ciprofloxacin 0.3%, and ofloxacin 0.3%). These include enhanced spectrum and potency for Gram-positive cocci and possibly atypical mycobacterial species, improved penetration into the anterior segment, and reduced propensity to promote the development of resistance. Although published data and clinical experience with these agents is quite limited given their relatively recent entry into the U.S. market, this perspective will attempt to provide an understanding of the potential role of these newer fluorquinolones in addressing the problem of increasing fluoroquinolone resistance amongst bacterial ocular isolates.