Globe Rupture Medication
- Author: John R Acerra, MD; Chief Editor: Steven C Dronen, MD, FAAEM more...
The goal of pharmacotherapy is to prevent infections and pathophysiologic complications.
Prophylactic systemic antibiotics should be given to cover organisms commonly associated with posttraumatic endophthalmitis, including Bacillus species, S aureus,Pseudomonas species, gram-negative bacilli, anaerobes, corynebacteria, and streptococci. Topical antibiotics are also commonly given postoperatively.
The list below provides examples of potential antibiotic choices and is not an exhaustive discussion. The ultimate choice of antibiotics is based on the individual characteristics of the injury and the patient, the determination of the degree of risk for infection and the likely organisms involved, and a specific drug's intraocular penetration characteristics.
Third-generation cephalosporin. Treatment of infections of respiratory tract, urinary tract, skin, intra-abdominal and osteomyelitis, sepsis, and meningitis caused by susceptible gram-negative aerobic organisms such as Enterobacteriaceae and Pseudomonas.
Provides excellent coverage against staphylococcal organisms and Pseudomonas, but it is not a good antibiotic for streptococci or anaerobes. Has excellent penetration of the eye in IV form. Anaerobic coverage can be achieved with addition of clindamycin, which also covers streptococci, except for enterococci.
Aminoglycoside antibiotic for gram-negative coverage bacteria including Pseudomonas species. Synergistic with beta-lactamase against enterococci. Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.
Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as body space into which agent needs to distribute. Dose of gentamicin may be given IV/IM. Each regimen must be followed by at least trough level drawn on third or fourth dose, 0.5 h before dosing; may draw peak level 0.5 h after 30-min infusion.
May be used as an alternative to cefazolin for adults allergic to penicillin. Provides excellent gram-positive coverage, including Bacillus. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dose. Use creatinine clearance to adjust dose in patients with renal impairment.
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