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Antimicrobial Treatment: Routes/Dosages/Preparation/Adverse Effects, Antimicrobial Resistance, and Alternatives

  • Harry W. FlynnJr.
  • Nidhi Relhan Batra
  • Stephen G. Schwartz
  • Andrzej Grzybowski
Chapter
Part of the In Clinical Practice book series (ICP)

Abstract

  • Intravitreal antimicrobials :

    For presumed bacterial cases (in separate syringes):
    • Vancomycin 1 mg/0.1 mL (for coverage of gram-positive organisms)

    • Ceftazidime 2.25 mg/0.1 mL (for coverage of gram-negative organisms)

    For presumed fungal cases:
    • Amphotericin B 0.005 mg/0.1 mL

    • Voriconazole 0.1 mg/0.2 mL

    For presumed bacterial cases: Vancomycin and ceftazidime in separate syringes

    For presumed fungal cases: Amphotericin B or voriconazole without intravitreal steroids
    • Amikacin may be substituted for ceftazidime (EVS proven efficacy).

    • Ceftriaxone (2 mg/0.1 mL) may be substituted for ceftazidime if more readily available.

    • Dexamethasone 4 mg/0.1 mL may be considered for acute-onset bacterial cases but should be avoided in suspected fungal endophthalmitis and delayed-onset (chronic) endophthalmitis until the organism is identified.

  • Periocular/subconjunctival antimicrobials and steroids: Periocular antibiotics may be helpful in bleb-related endophthalmitis.

  • Systemic antimicrobials :
    • For endogenous fungal endophthalmitis
      • Voriconazole 200 mg PO bid for 2–4 weeks

      • Fluconazole 200 mg PO bid for 2–4 weeks

      • Itraconazole 200 mg PO bid for 2–4 weeks

      • Ketoconazole 200 mg PO bid for 2–4 weeks

      • Amphotericin B 0.25–1.0 mg/kg IV every 6 hours as tolerated

    • For endogenous bacterial endophthalmitis
      • Vancomycin 1 g IV bid plus ceftazidime 1 g IV bid

      • Systemic fluoroquinolones for susceptible organisms

  • Topical antimicrobials:
    • Antibiotic topical therapy:
      • Fortified vancomycin: 25 mg/mL (2.5%) or 50 mg/mL (5%)

      • Fortified ceftazidime: 50 mg/mL (5%)

      • Fortified cefazolin: 50 mg/mL (5%)

      • Fortified gentamicin: 14 mg/mL (1.4%)

      • Fortified tobramycin: 14 mg/mL (1.4%)

      • Fortified amikacin: 8 mg/mL (2.5%)

      • Fortified linezolid: 2 mg/mL (0.2%)

      • Fortified imipenem–cilastin: 10 mg/mL (1%)

    • Antifungals eye drops:
      • Fortified amphotericin B: 1.5 mg/mL (0.15%)

      • Fortified voriconazole: 10 mg/mL (1%)

      • Itraconazole

  • Intrastromal antimicrobials:
    • Amphotericin B: 5–10 μg/0.1 mL

    • Voriconazole: 50 μg/0.1 mL

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Harry W. FlynnJr.
    • 1
  • Nidhi Relhan Batra
    • 1
  • Stephen G. Schwartz
    • 2
  • Andrzej Grzybowski
    • 3
    • 4
  1. 1.Department of OphthalmologyBascom Palmer Eye Institute, University of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of OphthalmologyBascom Palmer Eye Institute, University of Miami Miller School of MedicineNaplesUSA
  3. 3.Chair of OphthalmologyUniversity of Warmia and MazuryOlsztynPoland
  4. 4.Institute for Research in OphthalmologyPoznanPoland

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