Table 1.
First-line intravitreal antimicrobial agents for management of endophthalmitis.
| Antimicrobial agent | Name of drugs | Class of drugs | Mechanism of Action | Intravitreal dose |
|---|---|---|---|---|
| Antibiotics | Vancomycin (Vancocin®) |
Glycopeptide | Vancomycin acts by binding irreversibly to D-alanyl- D-alanine moieties of the N-acetylmuramic acid (NAM) and N-acetylglucosamine (NAG) peptides. This inhibits synthesis and cross-linking of the NAM/NAG polymers that form the backbone of the bacterial cell wall. |
1 milligram/0.1ml |
| Ceftazidime (Fortaz®) |
Cephalosporin (3rd generation cephalosporin) |
Ceftazidime interrupts cell wall synthesis via affinity for penicillin-binding proteins (PBPs). |
2.25 milligrams/0.1ml | |
| Amikacin (Amikin®) |
Aminoglycoside | Amikacin interrupts bacterial protein synthesis by binding to the 30S ribosome of susceptible organisms. |
0.4 milligram/0.1ml | |
| Antifungals | Amphotericin-B (Fungizone® |
Polyene | Amphotericin B binds with ergosterol, a component of fungal cell membranes, forming pores that cause rapid leakage of intracellular material and subsequent fungal cell death. |
5-10 micrograms/0.1ml |
| Voriconazole (Vfend®) |
Azole | Voriconazole causes inhibition of cytochrome P450 (CYP 450)–dependent 14α-lanosterol demethylation, which is a vital step in cell membrane ergosterol synthesis by fungi. |
50-100 micrograms/0.1ml |