A concern for ophthalmic antibiotic resistance in Bangladesh

In 2022, Bangladesh witnessed a sudden surge in conjunctivitis infections with some hospitals reporting three times the usual patient load with conjunctivitis [1]. According to media reports, conjunctivitis, characterized by red eyes, eye pain, and irritation, may have spiked in Bangladesh since July 2022 and reached its peak by September [2]. The outbreak of conjunctivitis has been reported mainly in Chattogram, Dhaka, Sylhet, Narayanganj and Faridpur regions [3]. Conjunctivitis in most cases is caused by viral infections. In the current outbreak, nearly half of these patients are infected with human adenovirus [1]. Bangladesh has noted an outbreak of conjunctivitis during the COVID-19 pandemic with eye-related manifestations such as red eye, itching, watering, vision loss, acute infection and inflammation [4, 6]. Earlier outbreaks of acute viral haemorrhagic conjunctivitis had also happened in 1981 caused by enterovirus 70 (EV 70) [7]. Viral infections and viral conjunctivitis do not need antibiotics unless there is an added bacterial infection. However, in the current outbreak, topical antibiotics such as Moxifloxacin, and Chloramphenicol are freely dispensed by pharmacy retailers without the prescription of health professionals [2]. In addition, there is also rampant use of Ciprofloxacin, Dexamethasone, and Natamycin for a viral eye infection [8]. These activities are a cause of concern in terms of antimicrobial stewardship and rising antimicrobial resistance of ocular pathogens such as Staphylococcus spp., coagulase-negative staphylococci, methicillin-resistant, and Haemophilus spp.) in recent decades has been a concern [9]. In 2017, a study of antibiotic susceptibility on bacteria collected from infected eyes in Bangladesh, Staphylococcus, Streptococcus, and Pseudomonas species were resistant to Gatifloxacin, Gentamicin, Tobramycin, Cloxacillin, Ciprofloxacin, Moxifloxacin, Cefixime, and Cephalexin [10]. An increase in ophthalmic antibiotic resistance may be a major problem when indicated in cataract surgery, corneal ulcers or bacterial eye infections. Raising public awareness regarding the judicious use of ophthalmic antibiotics is essential to avoid unprecedented ophthalmic epidemics and antimicrobial resistance burden. Regulations for self-medication, distribution, and selling antibiotics should include ophthalmic antibiotics. Bangladesh should initiate nationwide surveillance on antibiotic resistance in ocular microorganisms. Visualization; resources; writing – original draft; project administration: Md Nasir Ahmed. Conceptualization; writing – review and editing; supervision: Mohammed Rahmatullah. Validation; writing – review and editing: Rownak Jahan. Investigation: Chowdhury Alfi Afroze. We would like to thank the reviewers for their time and effort in reviewing the manuscript. The authors have declared no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analysed in this study.