Assessment of the effect of oral clarithromycin on visual outcome following presumed bacterial endophthalmitis.
OBJECTIVE
The use of clarithromycin was assessed as a biofilm reducing agent in the management of bacterial endophthalmitis.


METHODS
84 eyes of 83 patients presenting with clinical signs highly suggestive of bacterial endophthalmitis were treated using a standard regimen of intraocular vancomycin, amikacin and systemic steroids, which in addition included oral clarithromycin. Ocular penetration of oral clarithromycin in healthy and inflamed eyes was also assessed.


RESULTS
Comparing visual acuities at presentation and 6 months, 66% of patients demonstrated an improvement. Intraocular samples were culture positive in 58% of eyes. As compared to culture positive cases, more culture negative cases achieved a visual acuity of 6/12 or better (p = 0.0047). As compared to patients receiving the standard protocol but without clarithromycin, a greater number of culture negative cases demonstrated an improvement in vision of > or = + 6 Snellen lines (p = 0.023). The ocular penetration of clarithromycin into the anterior chamber of inflamed eyes appears sufficient to allow anti-biofilm activity against bacteria at the basic pH encountered in eyes with endophthalmitis.


CONCLUSIONS
The ocular penetration of clarithromycin appears adequate for anti-biofilm activity in inflamed eyes. The beneficial effects of oral clarithromycin on visual outcome has been demonstrated in culture negative eyes with clinical signs highly suggestive of bacterial endophthalmitis. The final visual outcome for culture positive cases remains poor.
Okhravi
N
N
Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom. nokhravi@hgmp.mrc.ac.uk
Guest
S
S
Matheson
M M
MM
Kees
F
F
Ficker
L A
LA
Tuft
S J
SJ
Lightman
S
S
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000378:metabolism; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D018441:Biofilms / Q000187:drug effects; D001682:Biological Availability; D017024:Chemotherapy, Adjuvant; D002648:Child; D017291:Clarithromycin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014792:Visual Acuity / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D017291:Clarithromycin