Irrational antimicrobial use is breeding resistant ocular pathogens — fluoroquinolone-resistant Pseudomonas, methicillin-resistant Staphylococcus aureus, and resistant Fusarium and Candida — a problem amplified in India by over-the-counter drops, empirical perioperative prophylaxis and steroid-antibiotic combinations. This perspective sets out an ophthalmology-specific stewardship model, RED EYE AMSP, adapting a national framework into ten points.
The practical core for a clinician is restraint and diagnostics. Use culture-guided therapy for recalcitrant or postsurgical infections rather than escalating empirically, restrict broad-spectrum and prolonged topical antimicrobials, enforce asepsis during procedures, and audit prescribing.
This reframes everyday prescribing — the reflex broad-spectrum drop, the just-in-case perioperative course — as a stewardship decision. Adopting culture-guided, time-limited treatment preserves the antimicrobials that endophthalmitis and keratitis depend on, and curbs the resistance already seen in practice.
- Resistant ocular pathogens now include fluoroquinolone-resistant Pseudomonas and resistant Fusarium and Candida.
- Use culture-guided therapy for recalcitrant or postsurgical infections rather than empirical escalation.
- Restrict broad-spectrum and prolonged topical antimicrobials and steroid-antibiotic combinations.
- Enforce asepsis during procedures and audit antimicrobial prescribing.
- Treat the reflex broad-spectrum drop and just-in-case prophylaxis as stewardship decisions.
Why it matters
Resistance in keratitis and endophthalmitis is already eroding the drugs sight-saving treatment relies on, and everyday prescribing habits drive it.
Don't overread it
This is a perspective proposing a stewardship model, not trial evidence that it changes resistance or outcomes.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ophthalmology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free