Pharmacokinetics of intravitreal antibiotics in endophthalmitis

Radhika, Medikonda; Mithal, Kopal; Bawdekar, Abhishek; Dave, Vivek Pravin; Jindal, Animesh; Relhan, Nidhi; Albini, Thomas A.; Pathengay, Avinash; Flynn, Harry W.

doi:10.1186/s12348-014-0022-z

Cited by 70 publications

(54 citation statements)

References 62 publications

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“…Based on our data and other recent reports, it appears that the concern for vancomycin resistance that is present in systemic infections is not applicable in this setting and that vancomycin remains a suitable first choice for empiric therapy. The high susceptibility rates of Gram-positive isolates to vancomycin consistently observed may be the result of the high vitreous concentrations of antibiotic consistently achieved following intravitreal injection 14 .…”

Section: Discussionmentioning

confidence: 97%

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

Kodati

Eller

Kowalski

2017

Ophthalmology Retina

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Purpose To investigate the in vitro susceptibility of Gram-positive and Gram-negative endophthalmitis bacterial isolates to vancomycin, amikacin, and ceftazidime over a 23-year period. Design Retrospective non-comparative laboratory case series. Subjects Endophthalmitis patients that were culture positive for bacteria. Methods Laboratory records of bacteria isolated from endophthalmitis specimens collected from January 1st 1993 to December 31st 2015 were reviewed for incidence and standard susceptibility testing. Main outcome measures The in vitro susceptibilities of bacteria cultured from endophthalmitis to vancomycin (VAN), amikacin (AMK), and ceftazidime (CEF). Results Patients with endophthalmitis were culture positive for bacteria in 665 cases.. Coagulase negative Staphylococci (CoNS) were the most common bacteria (54.6%), followed by Streptococci (Strep) species (20.8%), Staphylococcus aureus (SA) (10.2%), other Gram-positive (other-GP) bacteria (7.4%) and Gram-negative (GN) bacteria (7.1%). All Gram-positive organisms were susceptible to VAN, with the exception of 2 isolates. The in vitro susceptibilities of bacteria to AMK were: CoNS (95.3%), SA (75.0%), Strep (8.0%), GN (95.7%), and other-GP (81.1%). The in vitro susceptibilities of bacteria to CEF were: CoNS (58.5%), SA (54.4%), Strep (84.1%), GN (93.6.%), and other-GP (52.8%). There was no difference between AMK (95.7%) and CEF (93.6%) for GN coverage. AMK provided better coverage than CEF for CoNS, SA, and other-GP bacteria respectively (p<0.05, Fisher's exact), however, CEF appeared to provide better coverage (p<0.001, Fisher's exact) for Strep than AMK. Conclusions Based on standard in vitro susceptibility testing, vancomycin remains an optimal antibiotic choice for the treatment of Gram-positive endophthalmitis. AMK and CEF appear to provide equal GN coverage, but AMK appears to provide better coverage for CoNS, SA, and other-GP, but not Strep.

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Section: Discussionmentioning

confidence: 97%

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

Kodati

Eller

Kowalski

2017

Ophthalmology Retina

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“…The retinal toxicity of aminoglycoside has been well known for more than 20 years, especially in vitrectomized eyes 11–13. Beta-lactams antibiotics as well showed signs of retinal toxicity, since they have a posterior route of clearance from the eye 14. Intracameral cefuroxime caused retinal hemorrhage and infarction that resulted in very poor visual acuity in four patients in one published series,3 because of an inadvertent overdose of drug administered after uneventful cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety

Besozzi

Salvatore²,

Cardillo³

et al. 2018

OPTH

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BackgroundPostoperative endophthalmitis is a severe complication after intraocular surgery. The aim of this pilot study was to investigate the safety of intracameral cefuroxime in combined vitrectomy and phacoemulsification for cataract and various vitreoretinal disease.MethodsThe charts of 152 patients who underwent combined phacoemulsification, intraocular lens implant and pars plana vitrectomy were reviewed. The final tamponade was chosen among fluid, air, gas or silicone oil, based on the requirement of each single case. Patients were operated on by four different surgeons. At the end of surgery, 1 mg/0.1 mL of intracameral cefuroxime (Aprokam) was administered.ResultsThe mean follow-up was 6.26±7.78 months (range 1–12). No retinal complication, such as retinal infarction or hemorrhages were observed. No acute macular serous detachment and no new intraretinal cysts were noted, in those patients who received optical coherence tomography within the fifth day after surgery. No endophthalmitis was recorded.ConclusionIntracameral cefuroxime, at the end of combined phacoemulsification and pars plana vitrectomy, is safe as it has no toxicity on the retina and maybe could be considered effective in endophthalmitis prevention. Due to the relatively small number of patients, further studies are advisable.Summary statementThe standard dose of intracameral cefuroxime at the end of combined phacoemulsification and pars plana vitrectomy has no toxic effects on the retina. This paper/The abstract of this paper was presented at the European Vitreo Retinal Society Conference 2017 as a conference talk with interim findings. The poster’s abstract was not published.

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“…Lastly, following injection, the head is positioned such that the target seed lies inferiorly, utilizing gravity to settle the denser melphalan (1.32 g/cm 3 ) toward the seed(s) within the vitreous (1.02 g/cm 3 ) and away from regions most critical for vision (e.g., macula). Gravitational settling of intravitreal medication and head positioning have previously been described [12]. …”

Section: Discussionmentioning

confidence: 99%

Precision Intravitreal Chemotherapy for Localized Vitreous Seeding of Retinoblastoma

Dalvin

Welch

et al. 2018

Ocul Oncol Pathol

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Purpose: To describe and evaluate the effectivity of a novel precision intravitreal injection technique for select cases of localized vitreous seeding in retinoblastoma. Methods: Patients with localized vitreous seeds from retinoblastoma received intravitreal chemotherapy via a precision injection technique (P-IVitC) intended to optimize local delivery of melphalan to target seeds. The needle was inserted trans-pars plana and chemotherapy deposited within 3 mm of the target seed(s) under indirect ophthalmoscopic guidance. Without subsequent globe manipulation, the head was then positioned to promote gravity-dependent settling of chemotherapy. Results: There were 8 eyes of 8 patients treated with P-IVitC for active vitreous seeds following adequate solid tumor control with intravenous chemotherapy (n = 3, 38%) or intra-arterial chemotherapy (n = 5, 63%). Viable vitreous seeds were primarily solitary spheres (n = 6, 75%) and measured an average of 2.7 mm in diameter. Vitreous seed resolution (n = 8, 100%) was noted after a mean of 2.6 injections (median 2; range 1–3) of 20 μg melphalan. There was no recurrence at a mean follow-up of 10.0 months. Only 1 eye had an associated complication (focal retinal pigment epithelial mottling, n = 1, 13%). Conclusions: With direct delivery of chemotherapy to within 3–4 mm of vitreous seed activity, P-IVitC provided complete control of localized vitreous seeds with minimal toxicity.

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Pharmacokinetics of intravitreal antibiotics in endophthalmitis

Cited by 70 publications

References 62 publications

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety

Precision Intravitreal Chemotherapy for Localized Vitreous Seeding of Retinoblastoma

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