Endophthalmitis Medication

Author: Daniel J Egan, MD; Chief Editor: Robert E O'Connor, MD, MPH more...

Updated: Sep 19, 2011

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Medication Summary
Antibiotics
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Medication Summary

In postoperative endophthalmitis, parenteral therapy is not necessary unless evidence of infection exists outside the globe.

In other forms of endophthalmitis, administer broad-spectrum antibiotics once cultures have been obtained. An ophthalmologist usually administers intravitreal and subconjunctival injections. The following list of systemic antibiotics can be administered in conjunction with injection.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

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Vancomycin (Vancocin)

Empiric coverage for gram-positive organisms including B cereus. DOC for both intravitreal and systemic administration; excellent gram-positive coverage and has added advantage of providing better coverage against resistant organisms; bactericidal against most organisms and bacteriostatic for enterococci; inhibits cell wall biosynthesis, interfering with cell-membrane permeability and RNA synthesis.

After systemic administration, drug penetrates most tissues including vitreous, especially if the blood-ocular barrier is compromised. Use creatine clearance to adjust dose in patients with renal impairment.

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Gentamicin (Gentacidin, Garamycin)

Empiric coverage for gram-negative organisms including P aeruginosa. First choice aminoglycoside for systemic gram-negative coverage; bactericidal inhibitor of protein synthesis (30S ribosomal subunit).

Dosing regimens are numerous; adjust dose based on CrCl.

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Ceftazidime (Fortaz, Ceptaz)

Third-generation cephalosporin with broad gram-negative coverage but decreased efficacy to gram-positive organisms; gram-negative coverage includes Enterobacter, Citrobacter, Serratia, Neisseria, Providencia, and Haemophilus species.

Cephalosporins bind to one or more of the penicillin-binding proteins and prevent cell wall synthesis inhibiting bacterial growth.

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Ceftriaxone (Rocephin)

Third-generation cephalosporin that crosses blood brain barrier. Active against resistant bacteria including gonococci, H influenzae, and other gram-negative organisms.

Used in suspected hematogenous source for endophthalmitis in combination with vancomycin while cultures are pending. Cephalosporins bind to the penicillin binding protein and prevent cell wall synthesis, which inhibits bacterial growth.

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Cefotaxime (Claforan)

Third-generation cephalosporin that has broad gram-negative coverage but lower efficacy for gram-positive organisms. Cephalosporins bind to one or more of the penicillin-binding proteins and prevent cell wall synthesis inhibiting bacterial growth.

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Clindamycin (Cleocin)

Use in IV drug abusers or penetrating trauma with soil contamination for suspected B cereus infection. Semisynthetic antibiotic that inhibits bacterial protein synthesis by interfering with peptide bond formation at the 50S ribosomal subunit; has both bacteriostatic and bactericidal activity.

Class Summary

For suspected candidal or Aspergillus infection. Indicated in patients who are immunosuppressed, who have indwelling venous catheters, or who are currently taking broad-spectrum antibiotics.

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Amphotericin B (AmBisome)

Fungistatic or fungicidal depending on concentration attained in body fluids; polyene antibiotic produced by a strain of Streptomyces nodosus. Changes permeability of fungal cell membrane by binding to sterols, which causes fungal cell death as intracellular components leak out.

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Contributor Information and Disclosures

Author

Daniel J Egan, MD Associate Attending Physician, Department of Emergency Medicine, St Luke's Roosevelt Hospital Center

Daniel J Egan, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jessica Radin Peters MD, Attending Physician, Urgent Care Center, Newton-Wellesley Hospital

Jessica Radin Peters is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David A Peak, MD Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Lavely, MD, JD, MS, MPH Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Medscape 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

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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