Real-life comparison of three intravitreal antibiotic drug regimens in endophthalmitis

Autor: Aafreen Bari, Rohan Chawla, Deepanshi Mishra, Ujjwalkumar Das, Nasiq Hasan, Gita Satpathy, T Velpandian, Shorya V Azad, Pradeep Venkatesh, Rajpal Vohra, Atul Kumar
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Indian Journal of Ophthalmology, Vol 70, Iss 5, Pp 1696-1700 (2022)
Druh dokumentu: article
ISSN: 0301-4738
1998-3689
DOI: 10.4103/ijo.IJO_2640_21
Popis: Purpose: Real-life comparison of three intravitreal drug regimens used in cases of endophthalmitis at a tertiary care center in India. Methods: In this prospective, comparative study, patients of bacterial endophthalmitis were grouped according to intravitreal antibiotic drug regimens into Group 1 (ceftazidime and vancomycin), Group 2 (piperacillin + tazobactam and vancomycin), and Group 3 (imipenem and vancomycin). Forty-eight hours after injection nonresponding/worsening patients underwent vitrectomy. Vitreous samples were subjected to microbiological and pharmacokinetic tests. Results: A total of 64 patients were included and divided into Group 1: 29, Group 2: 20, and Group 3: 15 cases. Also, 75% of patients were post-surgical endophthalmitis, whereas 25% were post-traumatic. Improvement in vision (V90-0) and vision at 3 months (V90) were comparable between the three groups. Visual recovery was poorer in post-traumatic cases. In post-surgical cases, visual recovery was poorer in those presenting beyond 72 h of onset of symptoms (P = 0.0002). Polymerase chain reaction (PCR) positivity (66%) was higher than BACTECTM (33%) and culture (14%). Antibiotic resistance was comparable amongst the three groups. Most patients (62/64) further underwent vitrectomy. Ceftazidime and vancomycin achieved vitreous concentrations more than the minimum inhibitory concentration (MIC) at 48 h after the first injection. Conclusion: The choice of antibiotics did not affect the rate of vitrectomy and final vision in a real-life scenario. Ceftazidime and vancomycin can still be used as first-line intravitreal antibiotics owing to their comparable microbial sensitivity profile and adequate ocular bioavailability.
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