title: Intracameral cefuroxime and moxifloxacin used as endophthalmitis prophylaxis after cataract surgery: systematic review of effectiveness and cost-effectiveness.
abstract: Postoperative endophthalmitis is one of the most serious potential complications of ocular lens surgery. Its incidence can be reduced by means of antibiotic prophylaxis. Although the prophylactic use of intracameral cefuroxime has been extended, other drugs, such as moxifloxacin, have arisen as alternatives. We performed a systematic literature review on the effectiveness and efficiency of intracameral cefuroxime and moxifloxacin for the prophylaxis of postoperative endophthalmitis after cataract surgery. Several bibliographic databases were searched up to October 2010 and were updated up to January 2013. Outcomes were the onset of endophthalmitis after surgery and the cost-effectiveness ratio of using both antibiotic prophylaxis alternatives. The following were included: a clinical trial reported in two papers, six observational studies, and an economic evaluation. All studies assessed cefuroxime compared with another antibiotic prophylaxis or no prophylaxis. The only randomized controlled trial performed by the European Society of Cataract and Refractive Surgery found that intracameral cefuroxime is significantly more effective than not using prophylaxis or the use of a topical antibiotic. The observational studies support these results. The economic evaluation compared different prophylaxis regimens and concluded that intracameral cefuroxime showed the best cost-effectiveness ratio. Both the observational studies and the economic evaluation have methodological limits that reduce their validity. This review confirmed that cefuroxime can prevent endophthalmitis after cataract surgery. Further randomized controlled trials, with large sample sizes, are required to compare different antibiotic prophylaxis regimens.
authors.affiliation: Fundación Canaria de Investigación y Salud (FUNCIS), Santa Cruz de Tenerife, Spain ; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Renata
authors.initials: R
authors.lastname: Linertová
authors.affiliation: Ophthalmology Service, University Hospital Ntra Sra de La Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Abreu-González
authors.affiliation: Fundación Canaria de Investigación y Salud (FUNCIS), Santa Cruz de Tenerife, Spain ; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Pérez
authors.affiliation: Ophthalmology Service, University Hospital Ntra Sra de La Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Alonso-Plasencia
authors.affiliation: Ophthalmology Service, University Hospital of Canary Islands, La Laguna, Spain;
authors.forename: Luis Mateo
authors.initials: LM
authors.lastname: Cordovés-Dorta
authors.affiliation: Ophthalmology Service, University Hospital of Canary Islands, La Laguna, Spain;
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Abreu-Reyes
authors.affiliation: Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain ; HTA Unit, Canary Health Service, Santa Cruz de Tenerife, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Serrano-Aguilar
keywords: antibiotics; cefuroxime; endophthalmitis; intracameral; moxifloxacin; prophylaxis; systematic review