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Globe Rupture Medication

  • Author: John R Acerra, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
 
Updated: Oct 26, 2015
 

Medication Summary

The goal of pharmacotherapy is to prevent infections and pathophysiologic complications.

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Antibiotics

Class Summary

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.

Ceftazidime (Fortaz)

 

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.

Ciprofloxacin (Cipro)

 

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.

Gentamicin (Garamycin, Jenamicin)

 

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.

Vancomycin (Vancocin)

 

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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Contributor Information and Disclosures
Author

John R Acerra, MD Assistant Professor, Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine; Director, International Emergency Medicine Fellowship, North Shore-LIJ Health System

John R Acerra, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Derek J Golden, MD Attending Physician, Department of Emergency Medicine, West Hills Hospital and Medical Center

Derek J Golden, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Joe Robson, MD, Amy J Behrman, MD, and Stephanie Abbuhl, MD, to the development and writing of this article.

References
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Operating microscope view of a globe rupture secondary to blunt trauma by a fist. Notice the dark arc in the bottom of the photo representing the ciliary body visible through the scleral breach. Subconjunctival hemorrhage of this severity should raise suspicion of occult globe rupture. Photo courtesy of Brian C Mulrooney, MD.
 
 
 
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