Subconjunctival delivery of antibiotics in a controlled-release system: a novel anti-infective prophylaxis approach for cataract surgery.
OBJECTIVE
To compare the efficacy of subconjunctival injection of a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL, in a controlled-release system (DuoCat) with that of ciprofloxacin hydrochloride, 0.3%, eyedrops for infection prophylaxis.


METHODS
Rabbit eyes were injected subconjunctivally with a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL, or ciprofloxacin hydrochloride, 2 mg/0.1 mL, alone. The aqueous and vitreous humor pharmacokinetic profiles were compared with those of a single drop of ciprofloxacin hydrochloride, 0.3%, 6 times daily. In 45 rabbits, Staphylococcus aureus was injected into the anterior chamber: 15 randomly received 1 drop of ciprofloxacin hydrochloride, 0.3%, every 4 hours during 24 hours; 15 received drops of balanced salt solution; and 15 received a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL. After 24 hours, endophthalmitis scores were recorded, aqueous and vitreous humors underwent culture, and histologic analysis was performed.


RESULTS
The combined triamcinolone and ciprofloxacin treatment allowed higher intraocular levels of ciprofloxacin. The median endophthalmitis clinical scores for the combination of triamcinolone and ciprofloxacin and ciprofloxacin-only eyedrop groups were equivalent (P = .42) and were significantly lower than those of the balanced salt solution group (P < .001). The culture was negative for S aureus in the combined triamcinolone and ciprofloxacin and ciprofloxacin eyedrop regimens. No adverse effects were observed with either route.


CONCLUSIONS
Ciprofloxacin eyedrops and combined triamcinolone and ciprofloxacin were equally tolerated and efficacious. The combined triamcinolone and ciprofloxacin treatment may eliminate noncompliance issues and may prove to be a valuable clinical tool for surgical prophylaxis.


CONCLUSIONS
The combined triamcinolone and ciprofloxacin treatment may be a new useful strategy for surgical prophylaxis.
Cardillo
José A
JA
Hospital de Olhos de Araraquara, Araraquara, São Paulo, Brazil.
Paganelli
Fernando
F
Melo
Luiz A S
LA
Silva
Arnobio A
AA
Pizzolitto
Antonio C
AC
Oliveira
Anselmo G
AG
D000818:Animals; D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001082:Aqueous Humor / Q000378:metabolism / Q000382:microbiology; D001682:Biological Availability; D002387:Cataract Extraction; D002851:Chromatography, High Pressure Liquid; D002939:Ciprofloxacin / Q000493:pharmacokinetics / Q000627:therapeutic use; D003228:Conjunctiva; D003692:Delayed-Action Preparations; D004337:Drug Carriers; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000378:metabolism / Q000382:microbiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000378:metabolism / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D019344:Lactic Acid; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011817:Rabbits; D013203:Staphylococcal Infections / Q000378:metabolism / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014221:Triamcinolone / Q000493:pharmacokinetics / Q000627:therapeutic use; D014822:Vitreous Body / Q000378:metabolism / Q000382:microbiology
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; D004337:Drug Carriers; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D014221:Triamcinolone; D011100:Polyglycolic Acid; D019344:Lactic Acid; D002939:Ciprofloxacin