Empiric treatment of endophthalmitis. Are aminoglycosides necessary?
OBJECTIVE
To reevaluate the necessity of empiric gram-negative therapy for postoperative endophthalmitis based on the recognition of aminoglycoside-induced toxic effects.


METHODS
A review of 162 cases of culture-positive bacterial endophthalmitis to determine bacterial prevalence, antibiotic susceptibilities, and laboratory staining results of intraocular material.


RESULTS
One hundred fifty (93%) gram-positive and 12 (7%) gram-negative isolates. All the gram-positive bacteria were susceptible to vancomycin hydrochloride; and gram-negative bacteria were susceptible to gentamicin sulfate, amikacin sulfate, and ceftazidime sodium. Bacterial rods were observed on smear of intraocular material in 10 gram-negative cases submitted for examination.


CONCLUSIONS
Vancomycin is an appropriate single agent if laboratory studies rule out gram-negative infection. In the absence of laboratory support, an aminoglycoside (possible toxic effects) or another gram-negative antibiotic (possibly ceftazidime) should also be administered.
Donahue
S P
SP
Department of Ophthalmology, University of Pittsburgh, Pa.
Kowalski
R P
RP
Eller
A W
AW
DeVaro
J M
JM
Jewart
B H
BH
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002442:Ceftazidime; D002511:Cephalosporins / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011183:Postoperative Complications; D014640:Vancomycin / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D002442:Ceftazidime