Corneal Laceration Medication

  • Author: Andrew A Aronson, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 12, 2011
 

Medication Summary

Recommendations include a combination of a cephalosporin (eg, cefazolin) or vancomycin and an aminoglycoside (eg, gentamicin). In addition, add clindamycin if an intraocular foreign body is present or if vegetable matter has contaminated the wound. The most common organisms identified in posttraumatic endophthalmitis are Staphylococcus epidermidis, bacilli species, streptococci species, and gram-negative species. Fungal endophthalmitis is a relatively rare entity but should be considered in a patient who is recently post-surgical, immunocompromised, unresponsive to antibiotic treatment, or has a history of trauma with vegetable matter. Treatment should be discussed with the ophthalmology consultant if this is suspected.

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Antibiotics

Class Summary

These agents are used in prophylaxis of endophthalmitis. Therapy must cover all likely pathogens in the context of the clinical setting.

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Cefazolin (Ancef, Kefzol, Zolicef)

 

First-generation cephalosporin antibiotic for gram-positive bacterial coverage. Commonly used in combination with an aminoglycoside to achieve broad-spectrum coverage.

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Gentamicin (Gentacidin, Garamycin)

 

Aminoglycoside that provides coverage for most gram-negative organisms causing endophthalmitis.

Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes.

Not the antibiotic of first choice. Consider using this aminoglycoside when penicillins or other less toxic drugs are contraindicated, when bacterial susceptibility tests and clinical judgment indicate its use, and in mixed infections caused by susceptible strains of staphylococci and gram-negative organisms.

Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in the volume of distribution. May be administered IV or IM.

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Clindamycin (Cleocin)

 

Lincosamide useful as a treatment against serious skin and soft tissue infections caused by most staphylococci. Effective against aerobic and anaerobic streptococci, except enterococci.

Use in the prophylaxis of endophthalmitis when a foreign body is present or if the injury was soil or farm related to provide an effective agent against bacilli species.

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Vancomycin (Vancocin)

 

Potent antibiotic directed against gram-positive organisms and active against enterococci species.

Can be used as an alternative to cefazolin to provide coverage for most gram-positive organisms causing endophthalmitis.

Use in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing GI or GU procedures.

To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose (drawn 0.5 h prior to next dosing). Use creatinine clearance to adjust the dose in patients with renal impairment.

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Contributor Information and Disclosures
Author

Andrew A Aronson, MD, FACEP  Vice President, Physician Practices, Bravo Health Advanced Care Center; Consulting Staff, Department of Emergency Medicine, Taylor Hospital, Ridley Park, Pennsylvania

Andrew A Aronson, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nelson M Yang, MD  Staff Physician, Department of Emergency Medicine, Allegheny General Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Douglas Lavenburg, MD  Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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