ASK DIS: IntraOcular Foreign Body: Antibiotics

Prophylaxis

If there is any anticipated delay in surgical intervention, antibiotic prophylaxis should be administered as soon as possible.
Broad-spectrum intravenous therapy (vancomycin, ancef, ceftazidime and/or newer generation fluoroquinolones) or oral fourth-generation fluoroquinolones (moxifloxacin) are generally acceptable choice

Endophthalmitis

potentially devastating consequence of ocular trauma and develops in 8% to 13% of IOFB cases.
Presentation >24 hours after injury, age >50 years, IOFBs composed of steel, and organic or soil-contaminated IOFBs are all risk factors for endophthalmitis.
In cases in which endophthalmitis is suspected, antibiotics must be started immediately, and removal of the IOFB should proceed as soon as possible.
To decrease the risk of endophthalmitis, removal of the IOFB should be done concurrently with primary globe repair and administration of intravitreal and topical antibiotics.
No standard criteria exist to guide antibiotic use for eyes with IOFBs.
As previously noted, systemic antibiotics with broad-spectrum coverage and adequate intraocular penetration are preferred (cefazolin, ceftazidime, vancomycin, and third- or fourth-generation fluoroquinolones are potential choices) in all cases.
Oral fourth-generation fluoroquinolones (gatifloxacin and moxifloxacin) have also been shown to achieve significant levels of penetration into the vitreous cavity

Mode of administration: Intravitreal

Intravitreal injection at the time of surgery is a critical component of management of cases of endophthalmitis with IOFB.
A combination of vancomycin and either ceftazidime (preferred due to less retinotoxicity) or amikacin (better coverage of Bacillus species) should be used
there may be a role for intravitreal antibiotic injection at the time of presentation with plans for surgical remediation as soon as feasible.
The use of intravitreal antibiotics in cases without signs of infection is debated as the potential for side effects, such as allergy, toxicity and development of resistance, must be weighed against the potential benefits.
Intraoperatively, 0.1 ml each of intravitreal vancomycin (1 mg/ml) and ceftazidime (2.25 mg/ml) should be administered.

Mode of administration : Topical

systemic and topical antimicrobials (effective against Bacillus cereus if the injury involved contamination with soil or vegetation) are indicated; they include ceftazidime 1 g IV q 12 h, in combination with vancomycin 15 mg/kg IV q 12 h and moxifloxacin 0.5% ophthalmic solution q 1 to 2 h.
Ointment should be avoided if the globe is lacerated

Mode of administration : Systemic

Although the effectiveness of systemic antibiotics to decrease the incidence of endophthalmitis has not been shown, their use should be considered while awaiting definitive surgical therapy if the surgery cannot be done within 24 hours.
Owing to their broad spectrum of activity and bioavailability, the third- and fourth-generation fluoroquinolones are generally recommended.
In a retrospective study of 79 eyes for which removal was delayed for more than one month because of military conditions, the use of topical and systemic antibiotics produced good visual outcomes
Empirical oral ciprofloxacin and clindamycin combination may be as safe and effective as i.v. therapy in the management of orbital cellulitis
some study also claims although oral ciprofloxacin may be a beneficial adjunctive therapy, the use of oral ciprofloxacin alone may not be adequate for perioperative prophylaxis or for treatment of bacterial endophthalmitis.
based on animal studies, systemically administered ciprofloxacin achieved intravitreous levels exceeding minimum inhibitory concentrations for common ocular pathogens, suggesting a role for ciprofloxacin in the prophylaxis of posttraumatic endophthalmitis

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