title: Intraocular penetration of systemic antibiotics in eyes with penetrating ocular injury.
abstract: OBJECTIVE
  To determine whether penetrating scleral or corneal injury can enhance intraocular penetration of systemic moxifloxacin, vancomycin, and ceftazidime.
  
  
  METHODS
  Thirty rabbits were divided into 3 groups for each antibiotic and then further subdivided to receive either scleral or corneal injury to the right eye. The left eye served as a control. Intravenous antibiotics were given following injury, and eyes were subsequently enucleated. Vitreous antibiotic concentration was determined by high-performance liquid chromatography analysis. Plasma concentration was measured for comparison.
  
  
  RESULTS
  Intravitreal moxifloxacin concentration was unchanged by injury. Minimum inhibitory concentration (MIC90) was achieved in the vitreous against the most common gram-positive endophthalmitis-causing organisms. Intravitreal vancomycin levels were not enhanced by injury and did not reach the MIC90 for gram-positive organisms commonly causing intraocular infection. Intravitreal ceftazidime was increased in the injured eyes, 67% and 73% higher in scleral and corneal injury eyes. It reached MIC90 of many gram-negative bacteria.
  
  
  CONCLUSIONS
  Intravitreal antibiotic penetration of systemic antibiotics with or without penetrating ocular injury varies depending on the antibiotic. For prevention or treatment of gram-positive-bacteria-causing endophthalmitis, intravitreal vancomycin is necessary and provides the most reliable coverage. Systemic ceftazidime can be used for many gram-negative bacteria, but intravitreal injection is recommended for better coverage, especially for more-potent organisms. Systemic moxifloxacin can be considered for most gram-positive and -negative infections due to its excellent intraocular penetration and broad coverage, but the patient's previous history of its topical use and increasing resistance patterns must be considered.
authors.affiliation: Department of Ophthalmology, Henry Ford Medical Center , West Bloomfield, Michigan.
authors.forename: Shareef
authors.initials: S
authors.lastname: Ahmed
authors.forename: Oscar
authors.initials: O
authors.lastname: Kuruvilla
authors.forename: David Chin
authors.initials: DC
authors.lastname: Yee
authors.forename: Himanshu
authors.initials: H
authors.lastname: Aggarwal
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Paul
authors.initials: P
authors.lastname: Edwards
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Qiao
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002442:Ceftazidime / Q000008:administration & dosage / Q000494:pharmacology; D065306:Corneal Injuries / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control; D015807:Eye Injuries, Penetrating / Q000188:drug therapy / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000493:pharmacokinetics; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D058449:Intravitreal Injections; D000077266:Moxifloxacin; D011817:Rabbits; D012590:Sclera / Q000293:injuries / Q000378:metabolism / Q000382:microbiology; D014640:Vancomycin / Q000008:administration & dosage / Q000493:pharmacokinetics; D014822:Vitreous Body / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D014640:Vancomycin; D002442:Ceftazidime; D000077266:Moxifloxacin