Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin

Abstract

To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.

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

“…This approach would seem to be on line with the thinking of Dr O'Brien et al 18 After putting in perspective the current antibiotic cataract surgery prophylaxes, these authors 18 stated that the potential changes in bacterial sensibility patterns, emergence of new pathogens, advances in antimicrobial therapy, and modes of delivery highlight the need for continued investigation and periodic guideline reviews to optimise patient care. As regards adapting our cataract surgery prophylaxis to the newest European protocols, 5,8 the CNS methicillin resistance that we found (48.7%) was rather higher than The cataract surgery prophylaxis target E Ferná ndez-Rubio et al this resistance that was in Sweden (6.8% in the conjunctival bacteria 19 and 4.5% among the bacteria isolated in their PE cases after cataract operation; 20 this low methicillin resistance was one of the reasons for choosing cefuroxime in the Swedish cataract surgery prophylaxis 20 ).…”

“…On the other hand, taking into account our results and the need to use two different antibiotics, and according to other cataract surgery prophylaxis experiences outside Europe, 18,[29][30][31][32] it would be useful to investigate our conjunctival bacteria resistance to moxifloxacine in the near future. 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.…”

A Review of Antibiotic Prophylaxis for Post-operative Endophthalmitis

“…In addition, unlike gatifloxacin, moxifloxacin does not contain the preservative benzalkonium chloride. 17 Statistical comparisons of antibacterial activity based on MIC values showed moxifloxacin was significantly more potent than levofloxacin and the second-generation fluoroquinolones against fluoroquinolone-resistant coagulase-negative staphylococci. 17 Similar results favouring moxifloxacin were reported in a study testing the in vitro susceptibility of 77 bacterial endophthalmitis isolates to the ophthalmic fluoroquinolones.…”

“…17 Statistical comparisons of antibacterial activity based on MIC values showed moxifloxacin was significantly more potent than levofloxacin and the second-generation fluoroquinolones against fluoroquinolone-resistant coagulase-negative staphylococci. 17 Similar results favouring moxifloxacin were reported in a study testing the in vitro susceptibility of 77 bacterial endophthalmitis isolates to the ophthalmic fluoroquinolones. 18 In addition, the ocular concentrations of moxifloxacin achieved were consistently much higher than those occurring with topically instilled gatifloxacin, ciprofloxacin, ofloxacin or levofloxacin ophthalmic solutions.…”

“…These considerations make intracameral moxifloxacin an attractive option. 17 Numerous studies have been reported regarding the safety of intracameral moxifloxacin in various concentrations (0.1mg/0.1ml, 0.5mg/0.1ml and 250ug/0.05ml). Intracameral moxifloxacin has been found to be safe and effective for prophylaxis of endophthalmitis with no significant adverse effects on corneal endothelium and retinal thickness.…”