Empiric treatment of endophthalmitis. Are aminoglycosides necessary?
S. P. Donahue, R. P. Kowalski, A. W. Eller, J. M. DeVaro and B. H. Jewart
Department of Ophthalmology, University of Pittsburgh, Pa.
OBJECTIVE: To reevaluate the necessity of empiric gram-negative therapy for
postoperative endophthalmitis based on the recognition of
aminoglycoside-induced toxic effects. METHODS: A review of 162 cases of
culture-positive bacterial endophthalmitis to determine bacterial
prevalence, antibiotic susceptibilities, and laboratory staining results of
intraocular material. RESULTS: One hundred fifty (93%) gram-positive and 12
(7%) gram-negative isolates. All the gram-positive bacteria were
susceptible to vancomycin hydrochloride; and gram-negative bacteria were
susceptible to gentamicin sulfate, amikacin sulfate, and ceftazidime
sodium. Bacterial rods were observed on smear of intraocular material in 10
gram-negative cases submitted for examination. CONCLUSION: Vancomycin is an
appropriate single agent if laboratory studies rule out gram-negative
infection. In the absence of laboratory support, an aminoglycoside
(possible toxic effects) or another gram-negative antibiotic (possibly
ceftazidime) should also be administered.
