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. 2001 Nov;85(11):1289–1293. doi: 10.1136/bjo.85.11.1289

Intravitreal vancomycin and gentamicin concentrations in patients with postoperative endophthalmitis

I Gan 1, J T van Dissel 1, W Beekhuis 1, W Swart 1, J C van Meurs 1
PMCID: PMC1723787  PMID: 11673290

Abstract

BACKGROUND/AIMS—To study the intravitreal antibiotic concentrations and the efficacy of an intravitreal dosing regimen to treat patients with postoperative bacterial endophthalmitis. This regimen, based on pharmacokinetic/pharmacodynamic considerations, relies on a repeat antibiotic injection of a lower dose than is generally used.
METHODS—In consecutive patients with suspected postoperative endophthalmitis a vitreous biopsy for bacterial culture was taken before 0.2 mg vancomycin and 0.05 mg gentamicin were injected intravitreally. After 3 or 4 days a second biopsy was taken for bacteriological culture and to measure intravitreal vancomycin and gentamicin concentrations, followed by a repeat injection of 0.2 mg vancomycin.
RESULTS—17 patients entered the study. In 11 patients the initial bacterial culture was positive, predominantly coagulase negative staphylococci. All second vitreous biopsies were sterile. Intravitreal vancomycin levels varied between 2.6 and 18.0 µg/ml (mean 10.3 (SD 4.1) µg/ml) after 3 days and between 3.1 and 16.6 µg/ml (mean 7.5 (6.2) µg/ml) after 4 days which is well above the minimal inhibitory concentration for most micro-organisms. Concentrations of intravitreal gentamicin varied between 0.90 and 3.3 µg/ml (mean 1.6 (0.72) µg/ml) after 3 days and between 1.2 and 2.6 µg/ml (mean 1.9 (0.99) µg/ml) after 4 days.
CONCLUSION—This dosing regimen resulted both in adequate intravitreal vancomycin and gentamicin levels for over a week as well as in negative second cultures. This study also provides new information on intravitreal vancomycin and gentamicin concentration over time in patients with postoperative endophthalmitis.



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Figure 1  .

Figure 1  

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Intravitreal vancomycin concentrations.

Figure 2  .

Figure 2  

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Intravitreal gentamicin concentrations.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aguilar H. E., Meredith T. A., el-Massry A., Shaarawy A., Kincaid M., Dick J., Ritchie D. J., Reichley R. M., Neisman M. K. Vancomycin levels after intravitreal injection. Effects of inflammation and surgery. Retina. 1995;15(5):428–432. [PubMed] [Google Scholar]
  2. Baum J., Peyman G. A., Barza M. Intravitreal administration of antibiotic in the treatment of bacterial endophthalmitis. III. Consensus. Surv Ophthalmol. 1982 Jan-Feb;26(4):204–206. doi: 10.1016/0039-6257(82)90080-7. [DOI] [PubMed] [Google Scholar]
  3. Ben-Nun J., Joyce D. A., Cooper R. L., Cringle S. J., Constable I. J. Pharmacokinetics of intravitreal injection. Assessment of a gentamicin model by ocular dialysis. Invest Ophthalmol Vis Sci. 1989 Jun;30(6):1055–1061. [PubMed] [Google Scholar]
  4. Burkhart K. K., Metcalf S., Shurnas E., O'Meara O., Brent J., Kulig K., Rumack B. H. Exchange transfusion and multidose activated charcoal following vancomycin overdose. J Toxicol Clin Toxicol. 1992;30(2):285–294. doi: 10.3109/15563659209038639. [DOI] [PubMed] [Google Scholar]
  5. Campochiaro P. A., Lim J. I. Aminoglycoside toxicity in the treatment of endophthalmitis. The Aminoglycoside Toxicity Study Group. Arch Ophthalmol. 1994 Jan;112(1):48–53. doi: 10.1001/archopht.1994.01090130058017. [DOI] [PubMed] [Google Scholar]
  6. Cobo L. M., Forster R. K. The clearance of intravitreal gentamicin. Am J Ophthalmol. 1981 Jul;92(1):59–62. doi: 10.1016/s0002-9394(14)75908-2. [DOI] [PubMed] [Google Scholar]
  7. Coco R. M., López M. I., Pastor J. C., Nozal M. J. Pharmacokinetics of intravitreal vancomycin in normal and infected rabbit eyes. J Ocul Pharmacol Ther. 1998 Dec;14(6):555–563. doi: 10.1089/jop.1998.14.555. [DOI] [PubMed] [Google Scholar]
  8. Conway B. P., Campochiaro P. A. Macular infarction after endophthalmitis treated with vitrectomy and intravitreal gentamicin. Arch Ophthalmol. 1986 Mar;104(3):367–371. doi: 10.1001/archopht.1986.01050150067028. [DOI] [PubMed] [Google Scholar]
  9. Cottingham A. J., Jr, Forster R. K. Vitrectomy in endophthalmitis. Results of study using vitrectomy, intraocular antibiotics, or a combination of both. Arch Ophthalmol. 1976 Dec;94(12):2078–2081. doi: 10.1001/archopht.1976.03910040738007. [DOI] [PubMed] [Google Scholar]
  10. Craig W. A. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998 Jan;26(1):1–12. doi: 10.1086/516284. [DOI] [PubMed] [Google Scholar]
  11. Ferencz J. R., Assia E. I., Diamantstein L., Rubinstein E. Vancomycin concentration in the vitreous after intravenous and intravitreal administration for postoperative endophthalmitis. Arch Ophthalmol. 1999 Aug;117(8):1023–1027. doi: 10.1001/archopht.117.8.1023. [DOI] [PubMed] [Google Scholar]
  12. Flynn H. W., Jr, Pulido J. S., Pflugfelder S. C., Davis J. L., Culbertson W. W., Roussel T. J., Miller D. Endophthalmitis therapy: changing antibiotic sensitivity patterns and current therapeutic recommendations. Arch Ophthalmol. 1991 Feb;109(2):175–176. doi: 10.1001/archopht.1991.01080020021012. [DOI] [PubMed] [Google Scholar]
  13. Han D. P., Wisniewski S. R., Wilson L. A., Barza M., Vine A. K., Doft B. H., Kelsey S. F. Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol. 1996 Jul;122(1):1–17. doi: 10.1016/s0002-9394(14)71959-2. [DOI] [PubMed] [Google Scholar]
  14. Kattan H. M., Flynn H. W., Jr, Pflugfelder S. C., Robertson C., Forster R. K. Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery. Ophthalmology. 1991 Feb;98(2):227–238. [PubMed] [Google Scholar]
  15. Kucukguclu S., Tuncok Y., Ozkan H., Guven H., Uguz A., Maltepe F. Multiple-dose activated charcoal in an accidental vancomycin overdose. J Toxicol Clin Toxicol. 1996;34(1):83–86. doi: 10.3109/15563659609020238. [DOI] [PubMed] [Google Scholar]
  16. McDonald H. R., Schatz H., Allen A. W., Chenoweth R. G., Cohen H. B., Crawford J. B., Klein R., May D. R., Snider J. D., 3rd Retinal toxicity secondary to intraocular gentamicin injection. Ophthalmology. 1986 Jul;93(7):871–877. doi: 10.1016/s0161-6420(86)33648-0. [DOI] [PubMed] [Google Scholar]
  17. Meredith T. A., Aguilar H. E., Shaarawy A., Kincaid M., Dick J., Niesman M. R. Vancomycin levels in the vitreous cavity after intravenous administration. Am J Ophthalmol. 1995 Jun;119(6):774–778. doi: 10.1016/s0002-9394(14)72784-9. [DOI] [PubMed] [Google Scholar]
  18. Panzarino V. M., Feldstein T. J., Kashtan C. E. Charcoal hemoperfusion in a child with vancomycin overdose and chronic renal failure. Pediatr Nephrol. 1998 Jan;12(1):63–64. doi: 10.1007/s004670050405. [DOI] [PubMed] [Google Scholar]
  19. Park S. S., Vallar R. V., Hong C. H., von Gunten S., Ruoff K., D'Amico D. J. Intravitreal dexamethasone effect on intravitreal vancomycin elimination in endophthalmitis. Arch Ophthalmol. 1999 Aug;117(8):1058–1062. doi: 10.1001/archopht.117.8.1058. [DOI] [PubMed] [Google Scholar]
  20. Peyman G. A., May D. R., Ericson E. S., Apple D. Intraocular injection of gentamicin. Toxic effects of clearance. Arch Ophthalmol. 1974 Jul;92(1):42–47. doi: 10.1001/archopht.1974.01010010046011. [DOI] [PubMed] [Google Scholar]
  21. Pflugfelder S. C., Hernández E., Fliesler S. J., Alvarez J., Pflugfelder M. E., Forster R. K. Intravitreal vancomycin. Retinal toxicity, clearance, and interaction with gentamicin. Arch Ophthalmol. 1987 Jun;105(6):831–837. doi: 10.1001/archopht.1987.01060060117045. [DOI] [PubMed] [Google Scholar]
  22. Piguet B., Chobaz C., Grounauer P. A. Rétinopathie toxique sur injection intravitréenne d'Amikacine et Vancomycine. Klin Monbl Augenheilkd. 1996 May;208(5):358–359. doi: 10.1055/s-2008-1035237. [DOI] [PubMed] [Google Scholar]
  23. Rowsey J. J., Newsom D. L., Sexton D. J., Harms W. K. Endophthalmitis: current approaches. Ophthalmology. 1982 Sep;89(9):1055–1066. doi: 10.1016/s0161-6420(82)34691-6. [DOI] [PubMed] [Google Scholar]
  24. Seawright A. A., Bourke R. D., Cooling R. J. Macula toxicity after intravitreal amikacin. Aust N Z J Ophthalmol. 1996 May;24(2):143–146. doi: 10.1111/j.1442-9071.1996.tb01569.x. [DOI] [PubMed] [Google Scholar]
  25. Smith M. A., Sorenson J. A., Lowy F. D., Shakin J. L., Harrison W., Jakobiec F. A. Treatment of experimental methicillin-resistant Staphylococcus epidermidis endophthalmitis with intravitreal vancomycin. Ophthalmology. 1986 Oct;93(10):1328–1335. doi: 10.1016/s0161-6420(86)33579-6. [DOI] [PubMed] [Google Scholar]
  26. Snavely S. R., Hodges G. R. The neurotoxicity of antibacterial agents. Ann Intern Med. 1984 Jul;101(1):92–104. doi: 10.7326/0003-4819-101-1-92. [DOI] [PubMed] [Google Scholar]
  27. Zachary I. G., Forster R. K. Experimental intravitreal gentamicin. Am J Ophthalmol. 1976 Oct;82(4):604–611. doi: 10.1016/0002-9394(76)90549-3. [DOI] [PubMed] [Google Scholar]

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