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British cataract surgeons report low use of prophylactic intracameral cefuroxime
Clin Experiment Ophthalmol. 2010;38(5):462-466.
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A majority of cataract surgeons reported reluctance to use prophylactic intracameral cefuroxime in patients with and without penicillin allergies, according to a British survey.
"Routine phacoemulsification and intraocular lens implantation is the commonest elective surgical procedure undertaken in the National Health Service and yet there is a wide variation in the use of prophylactic antibiotics in patients with or without 'penicillin allergy,' despite the European Society of Cataract and Refractive Surgeons recommendations of 2007," the study authors said. "Less than half of the surgeons working in smaller ophthalmic units routinely used intracameral cefuroxime and in 'penicillin allergy,' only one-third used cefuroxime. This survey highlights the reluctance of using cefuroxime in patients allergic to penicillin despite evidence to the contrary."
Investigators mailed questionnaires to ophthalmic surgeons working in smaller NHS ophthalmic units between December 2008 and April 2009. Smaller units had a maximum of eight consultant surgeons.
Surgeons were asked which antibiotics they used routinely for phacoemulsification and IOL implantation, what their usual route of administration was, and which antibiotics they preferred to use in patients reporting penicillin allergies.
The questionnaire was mailed to 401 consultant ophthalmic surgeons; 262 surgeons (65.34%) responded.
Results showed that 44.7% of surgeons used only intracameral cefuroxime; 31.7% used subconjunctival cefuroxime; 2.3% used only subconjunctival gentamicin; 6.9% used subconjunctival gentamicin or cefuroxime; 0.4% used subconjunctival cefotaxime; 0.4% used subconjunctival ceftazidime; and 0.8% used no prophylactic antibiotics.
Data showed that 103 surgeons (37%) used cefuroxime in patients reporting penicillin allergies; 47% of surgeons opted for gentamicin to treat those patients, the authors said.
The heavy reliance on intracameral cefuroxime among European surgeons for prophylaxis of postoperative endophthalmitis in the wake of the ESCRS study is reflected here in the nearly 50% of respondents who use this method alone (see also, for example, Gore DM, Angunawela RI, Little BC. United Kingdom survey of antibiotic prophylaxis practice after publication of the ESCRS Endophthalmitis Study. J Cataract Refract Surg. 2009;35(4):770-3). The use of intracameral cefuroxime, and the secondary preference for subconjunctival antibiotics, contrast sharply with patterns in the U.S., where, in 2007, 77% of surgeons were not injecting intracameral antibiotics and 98% were using postoperative topical antibiotics, almost entirely fourth-generation fluoroquinolones (Chang DF, Braga-Mele R, Mamalis N, Masket S, Miller KM, Nichamin LD, Packard RB, Packer M; ASCRS Cataract Clinical Committee. Prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg. 2007;33(10):1801-5).
– Mark Packer, MD, FACS
Drs. Fine,
Hoffman & Packer, Eugene, Ore.
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