Conjunctivitis

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Conjunctivitis is an infectious disease that affects the eye [1]. This disease occurs when the conjunctiva of the eye becomes inflamed, creating a noticeable “pink” coloring and swelling of the conjunctiva [1][2]. Conjunctivitis is prone to infect individuals of all ages, from childhood to adulthood [3]. While America has the resources needed to prevent outbreaks of conjunctivitis from occurring among its population, developing countries are most vulnerable to this disease, especially with its prevalence in newborns and children [9]. Thus, funding the affordable antibiotic for this disease will allow third world countries to increase their ability to provide resources to target and decrease its prevalence.

Known as the most common eye disease, conjunctivitis spreads through the contamination of the eye by microbes, which is usually due to the conjunctiva's contact with contaminated objects, such as hands or foreign objects [ 4 ]. The eye’s defense structure is comprised of several different parts, which includes the conjunctiva, eyelids, and tear ducts [1]. The conjunctiva serves as the membrane protecting the delicate pieces and functions of eye, especially the cornea [4]. Before conjunctivitis develops, the specific infectious agents of conjunctivitis must attack the defense mechanisms of the eye [ 4 ]. .  Figure 1: Diagram of the complex structures of the eye.

The most common symptom of conjunctivitis is a pinkish or red coloring of the whites of the eye. Additionally, the conjunctiva usually swells, accompanied by a sense of irritation [2]. Thus said, symptoms expressed tend to differ between viral and bacterial conjunctivitis infections [1]. Viral conjunctivitis infections are associated with other respiratory infection symptoms. Also, a watery discharge is usually emitted from eye. Bacterial conjunctivitis infections are more rapid, and emit a discharge of a yellow tained pus [1]. The conjunctivitis diseases usually spreads to both eyes to each method of infection; yet, this disease and its symptoms usually offset within 2 weeks [1]. However, an individual’s speed of recovery often depends on type of infection developed (i.e. bacterial, chemical exposure} [1]. Most common causes of conjunctivitis are caused through bacterial and viral infection [1]. Bacterial conjunctivitis infections tend to be more prevalent in children, and often caused by //Streptococcus pneumoniae// and other bacteria. Viral conjunctivitis infections tend to be more prevalent in adults and are often caused by adenovirus types 3, otherwise known as Pharyngoconjunctival Fever [1]. Additionally, conjunctivitis can be caused by allergens, dependent on the season, as well as exposure to harmful chemicals, such as prolonged exposure to eye medications or over use of eye cosmetics. [1].

For this research paper, bacterial conjunctivitis infections through the bacterial //Streptococcus pneumoniae// will be focused on. Bacterial conjunctivitis can be further classified in terms of infection severity. The bacterial hyperacute form is an rapid onset of the disease, can be developed from sexually transmitted diseases, such as //Neisseria gonorrhoeae//, followed by symptoms of heavy discharge [1]. Bacterial acute form commonly found in children, caused by //Streptococcus pneumoniae//, symptoms include moderate discharge [1]. Bacterial chronic, known as a very intense form of conjunctivitis, lasts longer than 4 weeks and is usually caused by bacteria such as //Staphylococcus// [1].

This disease affects nearly 6 million individuals in the US [4]. Thus said, drug costs for treatment, usually antibiotics, are very high. Normally, bacterial conjunctivitis can undergo three methods of treatment. First is a period of “wait-and-see”, which is the process of not delivering medication in favor of a chance the individual’s body will recover from the disease [8]. Another option is delayed treatment of antibiotics, which usually occurs after a period of waiting without seeing favorable results [8]. The most common option is the immediate treatment of the conjunctivitis through the use of antibiotics [8].


 * References: **

[1] Richards, A.; Guzman-Cottrill, J. A., Conjunctivitis. Pediatrics in Review2010, 36 (5), 196-028.

[2] N/A, Conjunctivitis: Overview. Institute for Quality and Efficiency in Health Care2015, N/A (N/A), 1.

[3] Epling, J., Bacterial conjunctivitis. BMJ Clin Evid 2012,2012.

[4] Azari, A. A.; Barney, N. P., Conjunctivitis: a systematic review of diagnosis and treatment. JAMA 2013,310 (16), 1721-9.

[5] Cavone, L.; Muzzi, M.; Mencucci, R.; Sparatore, B.; Pedrazzi, M.; Moroni, F.; Chiarugi, A., 18β-glycyrrhetic acid inhibits immune activation triggered by HMGB1, a pro-inflammatory protein found in the tear fluid during conjunctivitis and blepharitis. Ocul Immunol Inflamm 2011,19 (3), 180-5.

[6] Høvding, G., Acute bacterial conjunctivitis. Acta Ophthalmol 2008,86 (1), 5-17.

[7] N/A, Moxifloxacin. Tuberculosis 2008, 88 (2), 127-31.

[8] Benitez-Del-Castillo, J.; Verboven, Y.; Stroman, D.; Kodjikian, L., The role of topical moxifloxacin, a new antibacterial in Europe, in the treatment of bacterial conjunctivitis. Clin Drug Investig 2011,31 (8), 543-57.

[9] Shrestha, S. P.; Khadka, J.; Pokhrel, A. K.; Sathian, B., Acute bacterial conjunctivitis – antibiotic susceptibility and resistance to commercially available topical antibiotics in Nepal. Nepal J Ophthalmol2015, 8(15): 23-35

=__**Target Information** : __=

Antibiotics do not affect biochemical processes inside humans, such as transcription and mRNA. Thus, antibiotics are ‘programmed’ to differentiate between human cells and bacterial cells, mainly by distinguishing between the differences in their processes [6]. An example would be the ability to identify specific enzymes unique to bacterial cells. Overall, antibiotics work to target only the bacteria and prevent it from interacting with human cells [5]. Moxifloxacin targets DNA gyrase, an enzyme found in bacterial treated by the drug, such as //Streptococcus pneumoniae//. Due to its dependence on ATP, Moxifloxacin works to inhibit the enzymes from functioning [5]. Information about the molecular weight of DNA gyrase could not be found.

=__**Drug Information**** : **__=
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The drug this paper will focus on is Moxifloxacin. According to Shrestha, Moxifloxacin serves as the most cost effective drug offered to developing countries [9]. The formula of moxifloxacin is the following: C21H24FN3O4·HCl. The molecular weight of moxifloxacin is 437.89 grams per mole. Identified by CAS Number (186826-86-8). It targets the bacterial cells by increasing concentrations of moxifloxacin in the conjunctiva and inhibiting the bacteria causing the infection [5]. Since the disease occurs in the eye, the drug is injected in the form of eye drops [7].

Figure 2: Retrieved from SciFinder; image of the chemical formula of moxifloxacin.
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Figure 3: Retrieved from Pharmfile; Image of tablet form of Moxifloxacin.

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 * Other uses ** : can this drug be used to treat other diseases/conditions?

The drug selected to treat bacterial conjunctivitis is known as Moxifloxacin. The major company that produces, Bayer, labels it as Avelox. It is produced in form of intravenous solution (through IV) or tablet form [7]. Moxifloxacin is used to treat other bacterial caused diseases, such as Streptococcus pneumoniae. Several different type of market names Actimax (Sankyo); Actira (Bayer); Avelox (Bayer); Octegra (Bayer); Proflox (Esteve); Vigamox(Alcon). However, its main creator was Bayer [7]. Its scientific name is known as Moxifloxacin Hydrochloride. Side effects of this drug remain numerous. It contains a set of side effects that target the whole body, such as headaches, abdominal pain, reactions that occur in area of injection site. Additionally, it may affect the cardiosystem (palpitation, vasodilation), digestive system (dry mouth, vomiting, constipation), the central nervous system (insomnia, anxiety) and other major systems inside the human body [5]. Numerous amounts of clinical trials have been conducted with conjunctivitis and moxifloxacin [4][6]. Most trials are set up in way that either tested different forms of moxifloxacin or compared its outcome to that of other drugs. Minimal information could be found on its patent. Nonetheless, Moxifloxacin is derivative of fluoroquinolone antibacterial agent, and is used to treat other infections, such as pneumonia and sinusitis [5].