title: Combined meropenem and linezolid as a systemic treatment for postoperative endophthalmitis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the antibiotic treatment of postoperative endophthalmitis with combined systemic meropenem and linezolid.
  
  
  METHODS
  A retrospective analysis of endophthalmitis treated with systemic meropenem and linezolid compared to conventional systemic antibiotics by evaluation of outcome and adverse effects was carried out.
  
  
  RESULTS
  26 patients with unilateral postoperative endophthalmitis with a systemic combination regimen of meropenem (2 g TID, mean duration of treatment 5.5 days) and linezolid (600 mg BID, mean duration of treatment 8.9 days) (group 1, mean follow-up time 140 days) were included in this study and compared to 45 postoperative endophthalmitis patients treated with conventional systemic antibiotics (group 2; mean follow-up time 320 days). In group 1, 69.2 % of eyes additionally received intravitreal amikacin and vancomycin (vs. 24.4 % in group 2; p < 0.001), in 92.3 % pars plana vitrectomy was performed (vs. 68.9 % in group 2, p = 0.047). Mean best corrected visual acuity improved from a baseline of 1.76 logMar for group 1 and 1.83 logMar for group 2 to 0.91 logMar (p = 0.0001) and 0.90 logMar (p < 0.0001), respectively, at the end of the follow-up, revealing no significant differences between the two groups at any time point (p > 0.05). Ocular complications were observed in 34.6 % of eyes in group 1 (vs. 37.8 % in group 2; p > 0.05). Adverse drug effects occurred significantly more frequently in group 1 (26.9 % vs. 4.4 % p = 0.02).
  
  
  CONCLUSIONS
  In spite of the reported better penetration through the blood-ocular barrier and the broader antibacterial spectrum of meropenem and linezolid, no benefit in outcome was found in the present study. In contrast, adverse effects and costs of the combination regimen were significantly higher.
authors.affiliation: Department of Ophthalmology, Inselspital, University Hospital, Bern, Switzerland. christoph.tappeiner@insel.ch
authors.forename: C
authors.initials: C
authors.lastname: Tappeiner
authors.forename: K
authors.initials: K
authors.lastname: Schuerch
authors.forename: D
authors.initials: D
authors.lastname: Goldblum
authors.forename: S
authors.initials: S
authors.lastname: Zimmerli
authors.forename: J C
authors.initials: JC
authors.lastname: Fleischhauer
authors.forename: B E
authors.initials: BE
authors.lastname: Frueh
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D004338:Drug Combinations; D009877:Endophthalmitis / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D000077731:Meropenem; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D023303:Oxazolidinones / Q000008:administration & dosage*; D012189:Retrospective Studies; D013845:Thienamycins / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004338:Drug Combinations; D023303:Oxazolidinones; D013845:Thienamycins; D000077731:Meropenem; D000069349:Linezolid