{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:53:16Z","timestamp":1790261596810,"version":"4.1.0"},"reference-count":62,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Moxifloxacin is a fourth-generation fluoroquinolone antibiotic available for ophthalmic use. It inhibits two enzymes involved in bacterial DNA synthesis, covering Gram-positive and Gram-negative pathogens. This spectrum allows for the formulation of self-preserving bottle solutions, while its interesting pharmacological profile is distinguished by efficacy at low tissue concentrations and by an infrequent dose regimen due to its long duration on ocular tissues. This enhances patient compliance, promoting its use in children. The human eye hosts several microorganisms; this collection is called the ocular microbiota, which protects the ocular surface, assuring homeostasis. When choosing an antibiotic, it is appropriate to consider its influence on microbiota. A short dose regimen is preferred to minimize the impact of the drug. Moxifloxacin eyedrops represent an effective and safe tool to manage and prevent ocular infections. As healthcare providers face the complexity of the ocular microbiota and microbial resistance daily, the informed use of moxifloxacin is necessary to preserve its efficacy in the future. In this regard, it is well known that moxifloxacin has a lower capacity to induce resistance (an optimal WPC and MPC) compared to other quinolones, but much still needs to be explored regarding the impact that fluoroquinolones could have on the ocular microbiota.<\/jats:p>","DOI":"10.3390\/microorganisms12040649","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T14:00:23Z","timestamp":1711375223000},"page":"649","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Topical Antibiotic Therapy in the Ocular Environment: The Benefits of Using Moxifloxacin Eyedrops"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5206-540X","authenticated-orcid":false,"given":"Lorenzo","family":"Drago","sequence":"first","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS Multimedica Hospital, 20138 Milan, Italy"},{"name":"Clinical Microbiology and Microbiome Laboratory, Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1080\/17469899.2016.1203254","article-title":"Challenges of corneal infections","volume":"11","author":"Hazlett","year":"2016","journal-title":"Expert Rev. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2147\/OPTH.S1666","article-title":"Review of moxifloxacin hydrochloride ophthalmic solution in the treatment of bacterial eye infections","volume":"2","author":"Miller","year":"2008","journal-title":"Clin. Ophthalmol."},{"key":"ref_3","unstructured":"Vardanyan, R., and Hruby, V. (2016). Synthesis of Best-Seller Drugs, Elsevier Science."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.survophthal.2005.07.001","article-title":"Ocular Pharmacokinetics of Moxifloxacin after Topical Treatment of Animals and Humans","volume":"50","author":"Robertson","year":"2005","journal-title":"Surv. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/ICO.0b013e3181608561","article-title":"Ocular Penetration and Pharmacokinetics of Topical Gatifloxacin 0.3% and Moxifloxacin 0.5% Ophthalmic Solutions after Keratoplasty","volume":"27","author":"Holland","year":"2008","journal-title":"Cornea"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"831502","DOI":"10.1155\/2012\/831502","article-title":"New Treatments for Bacterial Keratitis","volume":"2012","author":"Wong","year":"2012","journal-title":"J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1001\/jamaophthalmol.2015.3888","article-title":"Antibiotic resistance among ocular pathogens in the United States: Five-year results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study","volume":"133","author":"Asbell","year":"2015","journal-title":"JAMA Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1046\/j.1469-0691.2002.00374.x","article-title":"Effect of moxifloxacin on secretion of cytokines by human monocytes stimulated with lipopolysaccharide","volume":"8","author":"Araujo","year":"2002","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2234459","DOI":"10.1001\/jamanetworkopen.2022.34459","article-title":"Effect of Topical Antibiotics on Duration of Acute Infective Conjunctivitis in Children. A Randomized Clinical Trial and a Systematic Review and Meta-analysis","volume":"5","author":"Honkila","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1016\/j.survophthal.2005.05.004","article-title":"Clinical Safety of Moxifloxacin Ophthalmic Solution 0.5% (VIGAMOX) in Pediatric and Nonpediatric Patients with Bacterial Conjunctivitis","volume":"50","author":"Silver","year":"2005","journal-title":"Surv. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.jpeds.2012.09.013","article-title":"A single-blinded randomized clinical trial comparing polimixin B-trimethoprim and moxifloxacin for treatment of acute conjunctivitis in children","volume":"162","author":"Williams","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.exer.2013.06.003","article-title":"Characterization of the normal microbiota of the ocular surface","volume":"117","author":"Willcox","year":"2013","journal-title":"Exp. Eye Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1463-5224.2004.00325.x","article-title":"The tear film and ocular mucins","volume":"7","author":"Davidson","year":"2004","journal-title":"Vet. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6738","DOI":"10.1167\/iovs.12-10750","article-title":"Gene expression in human accessory lacrimal glands of Wolfring","volume":"53","author":"Ubels","year":"2012","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s40123-023-00673-5","article-title":"Effect of liposomal- based eye drops on the conjunctival microflora of patients undergoing cataract surgery","volume":"12","author":"Giannaccare","year":"2023","journal-title":"Ophthalmol. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.exer.2013.07.014","article-title":"Antimicrobial compounds in tears","volume":"117","year":"2013","journal-title":"Exp. Eye Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1136\/bjo.2005.082289","article-title":"Expression of CRAMP via PGN-TLR-2 and of alpha-defensin-3 via CpG-ODN-TLR-9 in corneal fibroblasts","volume":"90","year":"2006","journal-title":"Br. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1167\/tvst.12.2.32","article-title":"Validation of 16S rRNA Gene Sequencing of the Periocular Microbiome and Lack of Alteration by Topical Eyedrops","volume":"12","author":"Priluck","year":"2023","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5408","DOI":"10.1167\/iovs.10-6939","article-title":"Diversity of bacteria at healthy human conjunctiva","volume":"52","author":"Dong","year":"2011","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jtos.2018.11.005","article-title":"Biogeography of the human ocular microbiota","volume":"17","author":"Ozkan","year":"2019","journal-title":"Ocul. Surf."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Huang, Y., Yang, B., and Li, W. (2016). Defining the normal core microbiome of conjunctival microbial communities. Clin. Microbiol. Infect., 22.","DOI":"10.1016\/j.cmi.2016.04.008"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/ICU.0000000000000931","article-title":"Perturbations of the ocular surface microbiome and their effect on host immune function","volume":"34","author":"Chang","year":"2023","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.preteyeres.2010.03.001","article-title":"Preservatives in eyedrops: The good, the bad and the ugly","volume":"29","author":"Baudouin","year":"2010","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"793565","DOI":"10.3389\/fmed.2022.793565","article-title":"Effects of Sodium Hyaluronate Eye Drops with or without Preservatives on Ocular Surface Bacterial Microbiota","volume":"9","author":"Zhong","year":"2022","journal-title":"Front. Med."},{"key":"ref_25","first-page":"361","article-title":"Cytotoxicity of ophthalmic preservatives on human corneal epithelium","volume":"9","author":"Tripathy","year":"1992","journal-title":"Lens Eye Toxic. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"543","DOI":"10.2165\/11589020-000000000-00000","article-title":"The role of topical moxifloxacin, a new antibacterial in Europe, in the treatment of bacterial conjiunctivitis","volume":"31","author":"Verboven","year":"2011","journal-title":"Clin. Drug Investig."},{"key":"ref_27","first-page":"1","article-title":"Current understanding of antibiotic associated dysbiosis and approaches for its management","volume":"10","author":"Kesavelu","year":"2023","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_28","first-page":"331","article-title":"Concentration of besifloxacin, gatifloxacin and moxifloxacin in human conjuctiva after topical ocular administration","volume":"4","author":"Torkidsen","year":"2010","journal-title":"Clin. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"109098","DOI":"10.1016\/j.exer.2022.109098","article-title":"Temporal impacts of topical ceftazidime and tobramycin-vancomycin mixtures on the ocular surface microbiota in rabbits","volume":"220","author":"Xue","year":"2022","journal-title":"Exp. Eye Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1136\/bmj.38128.631319.AE","article-title":"Predicting bacterial cause in infectious conjunctivitis: Cohort study on informativeness of combinations of signs and symptoms","volume":"329","author":"Rietveld","year":"2004","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1001\/jama.2013.280318","article-title":"Conjunctivitis: A systematic review of diagnosis and treatment","volume":"310","author":"Azari","year":"2013","journal-title":"JAMA"},{"key":"ref_32","first-page":"CD001211","article-title":"Antibiotics versus placebo for acute bacterial conjunctivitis","volume":"9","author":"Sheikh","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1197\/j.aem.2006.08.006","article-title":"Clinical features of bacterial conjunctivitis in children","volume":"15","author":"Patel","year":"2007","journal-title":"Acad. Emerg. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1097\/ICO.0b013e31820770f4","article-title":"Pediatric Ocular Surface Infections: A 5-year Review of Demographics, Clinical Features, Risk Factors, Microbiological Results, and Treatment","volume":"30","author":"Wong","year":"2011","journal-title":"Cornea"},{"key":"ref_35","first-page":"29","article-title":"A European Perspective on Topical Ophthalmic Antibiotics: Current and Evolving Options","volume":"3","author":"Chiambaretta","year":"2011","journal-title":"Ophthalmol. Eye Dis."},{"key":"ref_36","first-page":"227","article-title":"Efficacy of moxifloxacin in treating bacterial conjunctivitis: A metanalisys","volume":"33","author":"Kodikjuan","year":"2010","journal-title":"J. Fr. D\u2019Ophtalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1001\/archopht.1996.01100130080013","article-title":"Empirical or Culture-Guided Therapy for Bacterial Keratitis? A Plea for Data","volume":"114","year":"1996","journal-title":"Arch. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s40123-021-00435-1","article-title":"A One-Week Course of Levofloxacin\/Dexamethasone Eye Drops: A Review on a New Approach in Managing Patients after Cataract Surgery","volume":"11","author":"Rizzo","year":"2022","journal-title":"Ophthalmol. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1093\/jac\/48.suppl_1.17","article-title":"Establishing MIC breakpoints and the interpretation of in vitro susceptibility tests","volume":"48","author":"Wise","year":"2001","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/00055735-200408000-00007","article-title":"Fourth-generation fluoroquinolones: New topical agents in the war on ocular bacterial infections","volume":"15","author":"Mah","year":"2004","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/S0002-9394(02)01334-X","article-title":"Fourth generation fluoroquinolones: New weapons in the arsenal of ophthalmic antibiotics","volume":"133","author":"Mather","year":"2002","journal-title":"Am. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ijantimicag.2004.02.021","article-title":"Comparison of minimal inhibitory and mutant prevention drug con-centrations of 4 fluoroquinolones against clinical isolates of methicillinsusceptible and resistant Staphylococcus aureus","volume":"24","author":"Metzler","year":"2004","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_43","first-page":"41","article-title":"Kinetics of kill of bacterial conjunctivitis isolates with moxifloxacin, a fluoroquinolone, compared with the aminoglycosides tobramycin and gentamicin","volume":"4","author":"Wagner","year":"2010","journal-title":"Clin. Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.ajo.2013.10.003","article-title":"Conjunctival flora antibiotic resistance patterns after serial intravitreal injections without postinjection topical antibiotics","volume":"157","author":"Hsu","year":"2014","journal-title":"Am. J. Ophthalmol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1128\/CMR.00113-16","article-title":"Bacterial and Fungal Endophthalmitis","volume":"30","author":"Durand","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Flores-P\u00e1ez, L.A., Zenteno, J.C., Alc\u00e1ntar-Curiel, M.D., Vargas-Mendoza, C.F., Rodr\u00edguez-Mart\u00ednez, S., Cancino-Diaz, M.E., Jan-Roblero, J., and Cancino-Diaz, J.C. (2015). Molecular and Phenotypic Characterization of Staphylococcus epidermidis Isolates from Healthy Conjunctiva and a Comparative Analysis with Isolates from Ocular Infection. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135964"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1136\/bjophthalmol-2014-305030","article-title":"Microbiological isolates and antibiotic sensitivities in cul-ture-proven endophthalmitis: A 15-year review","volume":"98","author":"Moloney","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_48","first-page":"247","article-title":"Infectious endophthalmitis: Review of 420 cases","volume":"7","author":"Bhoomibunchoo","year":"2013","journal-title":"Clin. Ophthalmol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1016\/j.survophthal.2004.01.004","article-title":"Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones","volume":"49","author":"Hwang","year":"2004","journal-title":"Surv. Ophthalmol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1177\/112067210601600306","article-title":"Prophylaxis against Infection in Cataract Surgery: A Survey of Routine Practice","volume":"16","author":"Ang","year":"2006","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1016\/S0161-6420(91)32052-9","article-title":"Prophylaxis of endophthalmitis with topical povidone-iodine","volume":"98","author":"Speaker","year":"1991","journal-title":"Ophthalmology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.jcrs.2006.02.021","article-title":"ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study","volume":"32","author":"Barry","year":"2006","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Endophthalmitis Study Group European Society of Cataract & Refractive Surgeons (2007). Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors. J. Cataract. Refract. Surg., 33, 978\u2013988.","DOI":"10.1016\/j.jcrs.2007.02.032"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.jcrs.2018.12.019","article-title":"Comparative analysis of intravitreal tri-amcinolone acetonide\u2013moxifloxacin versus standard perioperative eyedrops in cataract surgery","volume":"45","author":"Nassiri","year":"2019","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.jcrs.2019.04.018","article-title":"Endophthalmitis reduction with intra-cameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries","volume":"45","author":"Haripriya","year":"2019","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1592\/phco.20.5.417.35062","article-title":"Comparison of the fluoroquinolones based on pharmacokinetic and pharmacodynamic parameters","volume":"20","author":"Pickerill","year":"2000","journal-title":"Pharmacotherapy"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.1093\/jac\/43.suppl_2.69","article-title":"Pharmacokinetics of the 8-methoxyquinolone, moxifloxacin: A comparison in humans and other mammalian species","volume":"43","author":"Siefert","year":"1999","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.ophtha.2004.09.029","article-title":"Penetration of topically applied gatifloxacin 0.3%, moxifloxacin 0.5%, and ciprofloxacin 0.3% into the aqueous humor","volume":"112","author":"Solomon","year":"2005","journal-title":"Opthalmology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1136\/bjophthalmol-2014-306502","article-title":"Aqueous penetration of orally and topically administered moxifloxacin","volume":"99","author":"Sharma","year":"2015","journal-title":"Br. J. Ophthalmol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.ajo.2007.03.036","article-title":"Differential Aqueous and Vitreous Concentrations of Moxifloxacin and Ofloxacin after Topical Administration One Hour before Vitrectomy","volume":"44","author":"Lai","year":"2007","journal-title":"Am. J. Ophthalmol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1001\/archopht.123.9.1282","article-title":"Evaluation of Moxifloxacin, Ciprofloxacin, Gatifloxacin, Ofloxacin, and Levofloxacin Concentrations in Human Conjunctival Tissue","volume":"123","author":"Wagner","year":"2005","journal-title":"Arch. Ophthalmol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/ICO.0b013e31824a8b9b","article-title":"Microbiota Evaluation of Patients with a Boston Type I Keratoprosthesis Treated with Topical 0.5% Moxifloxacin and 5% Povidone\u2013Iodine","volume":"32","author":"Nascimento","year":"2013","journal-title":"Cornea"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/4\/649\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:18:01Z","timestamp":1760105881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/4\/649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,25]]},"references-count":62,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["microorganisms12040649"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms12040649","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,25]]}}}