BACKGROUND/AIMS: To study the intravitreal antibiotic concentrations and the efficacy of an intravitreal dosing regimen to treat patients with postoperative bacterial endophthalmitis. This regimen, based on pharmacokinetic/pharmacodynamic considerations, relies on a repeat antibiotic injection of a lower dose than is generally used. METHODS: In consecutive patients with suspected postoperative endophthalmitis a vitreous biopsy for bacterial culture was taken before 0.2 mg vancomycin and 0.05 mg gentamicin were injected intravitreally. After 3 or 4 days a second biopsy was taken for bacteriological culture and to measure intravitreal vancomycin and gentamicin concentrations, followed by a repeat injection of 0.2 mg vancomycin. RESULTS: 17 patients entered the study. In 11 patients the initial bacterial culture was positive, predominantly coagulase negative staphylococci. All second vitreous biopsies were sterile. Intravitreal vancomycin levels varied between 2.6 and 18.0 microg/ml (mean 10.3 (SD 4.1) microg/ml) after 3 days and between 3.1 and 16.6 microg/ml (mean 7.5 (6.2) microg/ml) after 4 days which is well above the minimal inhibitory concentration for most micro-organisms. Concentrations of intravitreal gentamicin varied between 0.90 and 3.3 microg/ml (mean 1.6 (0.72) microg/ml) after 3 days and between 1.2 and 2.6 microg/ml (mean 1.9 (0.99) microg/ml) after 4 days. CONCLUSION: This dosing regimen resulted both in adequate intravitreal vancomycin and gentamicin levels for over a week as well as in negative second cultures. This study also provides new information on intravitreal vancomycin and gentamicin concentration over time in patients with postoperative endophthalmitis.
BACKGROUND/AIMS: To study the intravitreal antibiotic concentrations and the efficacy of an intravitreal dosing regimen to treat patients with postoperative bacterial endophthalmitis. This regimen, based on pharmacokinetic/pharmacodynamic considerations, relies on a repeat antibiotic injection of a lower dose than is generally used. METHODS: In consecutive patients with suspected postoperative endophthalmitis a vitreous biopsy for bacterial culture was taken before 0.2 mg vancomycin and 0.05 mg gentamicin were injected intravitreally. After 3 or 4 days a second biopsy was taken for bacteriological culture and to measure intravitreal vancomycin and gentamicin concentrations, followed by a repeat injection of 0.2 mg vancomycin. RESULTS: 17 patients entered the study. In 11 patients the initial bacterial culture was positive, predominantly coagulase negative staphylococci. All second vitreous biopsies were sterile. Intravitreal vancomycin levels varied between 2.6 and 18.0 microg/ml (mean 10.3 (SD 4.1) microg/ml) after 3 days and between 3.1 and 16.6 microg/ml (mean 7.5 (6.2) microg/ml) after 4 days which is well above the minimal inhibitory concentration for most micro-organisms. Concentrations of intravitreal gentamicin varied between 0.90 and 3.3 microg/ml (mean 1.6 (0.72) microg/ml) after 3 days and between 1.2 and 2.6 microg/ml (mean 1.9 (0.99) microg/ml) after 4 days. CONCLUSION: This dosing regimen resulted both in adequate intravitreal vancomycin and gentamicin levels for over a week as well as in negative second cultures. This study also provides new information on intravitreal vancomycin and gentamicin concentration over time in patients with postoperative endophthalmitis.
Authors: H R McDonald; H Schatz; A W Allen; R G Chenoweth; H B Cohen; J B Crawford; R Klein; D R May; J D Snider Journal: Ophthalmology Date: 1986-07 Impact factor: 12.079
Authors: T Boks; J T van Dissel; N Teterissa; F Ros; M H Mahmut; E D Utama; M Rol; P van Asdonk; S Airiani; J C van Meurs Journal: Br J Ophthalmol Date: 2006-05-10 Impact factor: 4.638
Authors: Ivan M Gan; Luana C Ugahary; Jaap T van Dissel; Jan C van Meurs Journal: Graefes Arch Clin Exp Ophthalmol Date: 2005-05-20 Impact factor: 3.117
Authors: Ivan M Gan; Luana C Ugahary; Jaap T van Dissel; Eric Feron; Ed Peperkamp; Marc Veckeneer; Paul G H Mulder; Gert Jan Platenkamp; Jan C van Meurs Journal: Graefes Arch Clin Exp Ophthalmol Date: 2005-10-19 Impact factor: 3.117
Authors: Eric W Lindstedt; Carlien A Bennebroek; Dymph J van der Werf; Marc Veckeneer; Annette Ossewaarde-van Norel; Chris C Mayland Nielsen; Rene J Wubbels; Jaap T van Dissel; Jan C van Meurs Journal: Graefes Arch Clin Exp Ophthalmol Date: 2014-08-10 Impact factor: 3.117
Authors: Ahmed B Sallam; Kyle A Kirkland; Richard Barry; Mohamed Kamel Soliman; Tayyeba K Ali; Sue Lightman Journal: Med Hypothesis Discov Innov Ophthalmol Date: 2018