Intracameral antibiotics: Questions for the United States based on prospective studies

Abstract

Recent prospective studies from Europe suggest the use of intracameral antibiotics for prophylaxis of endophthalmitis, although the studies did not make a comparison with the most common United States prophylaxis techniques. Thus, the European studies as well as the present literature were reviewed in an attempt to place the European studies in perspective with regard to the present U.S. protocol and the available literature. There is no worldwide-established approach to prophylaxis of endophthalmitis. In the absence of a strong evidence-based approach most surgeons use surrogate studies to support their techniques and mold their opinions based on their interpretation of the literature and when they believe organisms causing endophthalmitis enter the eye. The review showed that preoperative topical antibiotics limit the number of bacteria on the ocular surface at surgery and postoperative topical antibiotics are most appropriate to address postoperative inoculation until the wound is sealed (with no tapering). Whereas intracameral antibiotic injection may be an appropriate route of administration to address inoculation occurring at the time of surgery, more research on safety and effectiveness is needed before we expose the millions of eyes having cataract surgery each year. A multipronged approach to limit endophthalmitis risk is also needed, with antibiotics as only part of the strategy.

Profilaxis de la endoftalmitis postquirúrgica con cefuroxima intracamerular: experiencia de cinco años

“…Muchos oftalmólogos, sobre todo de Estados Unidos, muestran reticencias al uso de antibióticos intracamerulares en términos de seguridad y en términos médico-legales por la ausencia de un preparado comercial con aprobada vía de administración (11). Esto último es un hecho y no parece que haya una compañía farmacéutica dispuesta a su elaboración.…”

The antibiotic resistance pattern of conjunctival bacteria: a key for designing a cataract surgery prophylaxis

“…We propose the topical administration form in agreement with Dr Liesegang, 24 who recommends using topical antibiotics because of the concerns regarding intracameral antibiotics: preoperatively for limiting the number of bacteria at surgery, and postoperatively until the surgical wound is sealed.…”

“…This antibiotic seems to have the best pharmacologic and pharmacodynamic properties 18 and reduces the PE incidence to the levels as low as those achieved using intracameral cefuroxime, even when moxifloxacine was used topically. [29][30][31][32] Nevertheless, moxifloxacine resistance has appeared in America, causing acute PE cases, 24,30 which, besides the concerns regarding intracameral antibiotics, has addressed the need for a multipronged approach to limit the endophthalmitis risk, with antibiotics as only part of the strategy. 24 In this way and consistent with our results, it would be interesting to identify any clinical characteristic of the approximately 5% of patients harbouring The cataract surgery prophylaxis target E Ferná ndez-Rubio et al…”

Efficacy and Safety of Prophylactic Intracameral Gatifloxacin Injection in Cataract Surgery: 1 Year Results

“…Pre-and postoperative use of a topical antibiotic, such as povidone iodine; subconjunctival antibiotherapy; the addition of an antibiotic to the irrigation solution; oral systemic antibiotherapy; and the intracameral application of bolus doses of antibiotics have been used, as well as the intracameral injection of antibiotics, which has become the predominant method. [9] However a final determination of the safe dose of antibiotic for intraocular tissues is not yet certain. Despite multiple large-scale studies of prophylactic treatment with antibiotics, including vancomycin, cefuroxime, cefazolin, and moxifloxacin, a consensus has not yet been reached among the ophthalmology community.…”