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- W2000283108 abstract "We are pleased to hear of your low incidence of postoperative endophthalmitis. We favor the use of fourth-generation fluoroquinolones because they cover bacterial resistance to the second-generation and third-generation antibiotics, have broader coverage than the second-generation and third-generation fluoroquinolones for gram-positive bacteria, and are equally effective for gram-negative bacteria based on in vitro and in vivo studies.1,2 In addition, gatifloxacin and moxifloxacin are less prone to resistance development because of their resistance to single-step topoisomerase mutations and enhanced activity against gram-positive pathogens.3 Although Ness and Reinhard have seen a low incidence of endophthalmitis with a single use of ofloxacin preoperatively, Ta et al.4 performed a prospective randomized controlled trial comparing 3-day and 1-hour preoperative ofloxacin prophylaxis for cataract surgery. They found that 42% of eyes receiving 1-hour preoperative ofloxacin had positive conjunctival culture immediately before surgery, compared with 19% of eyes receiving 3 days of ofloxacin. Immediately after surgery, 34% of eyes with 1-hour prophylaxis compared with 14% of eyes receiving 3 days of prophylaxis had positive cultures. Furthermore, fewer bacteria were isolated from eyes receiving 3 days of prophylactic antibiotic. Likewise, Kowalski et al.5 found that commercially formulated moxifloxacin every 15 minutes preoperatively starting an hour before bacterial challenge and postoperatively with 4 drops separated by 4 hours prevented endophthalmitis in a rabbit model of endophthalmitis. Based on these results and our clinical experience, we believe that 3 days of prophylactic antibiotic use is superior to 1 antibiotic dose preoperatively. We agree with Ness and Reinhard that the efficacy of postoperative antibiotics after phacoemulsification is currently unknown. However, Mather et al.2 performed a prospective laboratory study in rabbit models that measured the effect of cataract surgery on the aqueous humor levels of topical moxifloxacin. They found no statistically significant difference in the penetration of topical moxifloxacin in eyes that had had cataract surgery compared with unoperated eyes. Furthermore, they discovered that a 3-drop schedule of moxifloxacin immediately after surgery produced aqueous concentrations that were well above the minimum inhibitory concentrations for resistant strains of the most common organisms implicated in endophthalmitis after cataract surgery. Until more studies have been performed, we are hopeful that the fourth-generation fluoroquinolones may be effective in eliminating bacteria that are introduced intraoperatively." @default.
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- W2000283108 date "2006-05-01" @default.
- W2000283108 modified "2023-10-18" @default.
- W2000283108 title "Reply : Perioperative antibiotics in phacoemulsification" @default.
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- W2000283108 doi "https://doi.org/10.1016/j.jcrs.2006.02.015" @default.
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