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US ophthalmologists still prefer fluoroquinolones in the prevention of endophthalmitis
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BERLIN — Controversy between the U.S. and Europe persists on the use of intracameral cefuroxime as a prophylaxis for endophthalmitis.
Prophylaxis with antibiotics, in addition to skin preparation with povidone iodine, is extremely important and should be intracameral, Terrence P. O'Brien, MD, said at the World Ophthalmology Congress here. However, U.S. physicians will not easily convert from fluoroquinolones to cefuroxime.
"Main limitation is that cefuroxime is not licensed for intraocular use and is therefore not available as a single-use preparation. In addition, a high rate of resistance has been shown amongst gram-positive organisms. Cefuroxime would not cover MRSA," he said.
In a study that Dr. O'Brien conducted at the Bascom Palmer Eye Institute, moxifloxacin was shown to have faster and more effective kinetics of kill compared with cefuroxime.
"Moxifloxacin killed more than 3 logs in less than 2 hours for susceptible Staphylococcus ocular isolates, while cefuroxime killed less than 1 log in 3 hours," he said.
He also announced that the newest fluoroquinolone, besifloxacin, has been shown to retain higher potency against organisms resistant to other fluoroquinolones.
"It's a novel, broad-spectrum [fluoroquinolone] with a potent antibacterial activity against prevalent ocular pathogens, including current drug-resistant strains. Bacteria develop resistance through mutations in the target enzymes, and high-level resistance to besifloxacin requires mutations in multiple targets," he said.
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