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    Optimal antibiotic regimen still controversial for endophthalmitis prophylaxis

    Topical antibiotics widely used despite lack of direct evidence proving their efficacy


    TAKE HOME MESSAGE: Accumulating evidence shows intracameral antibiotics decrease the risk of endophthalmitis after cataract surgery, but questions and concerns remain.



    La Jolla, CA—Antibiotic prophylaxis for cataract surgery remains a controversial topic, despite convincing data showing the efficacy of intracameral antibiotic use for reducing the risk of postoperative endophthalmitis, said Francis S. Mah, MD.antibiotic prophylaxis

    “The low rate of postoperative infection and the potential for many different variables to affect the risk make it difficult to conduct an appropriate large-scale clinical trial,” said Dr. Mah, director, corneal and external disease, and co-director, refractive surgery, Scripps Clinic, La Jolla, CA.

    The prospective study undertaken by the European Society of Cataract and Refractive Surgeons (ESCRS) provides the best evidence available, and subsequently, the efficacy of intracameral antibiotic prophylaxis has been demonstrated in other prospective studies, Dr. Mah said.

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    “However, there are still concerns about that approach and questions about the optimal technique,” he said.

    Reviewing the outcomes of the ESCRS study, members of the Infectious Disease Task Force of the American Society of Cataract and Refractive Surgery (ASCRS) concluded that intracameral antibiotic use may be a paradigm shift for endophthalmitis prophylaxis. However, continued research was needed to examine the optimal drug, dose, and method of delivery, as well as the short- and long-term effects.

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    In addition, widespread adoption would depend on access to a product that would be safe and simple to use with minimal risk of dilution errors and contamination, Dr. Mah said.

    Next: Single-use cefuroxime use

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