IntraOcular Foreign Body : Ciprofloxacin

IOFB Management

• Definitive management of an IOFB injury consists of timely repair of the entry site, removal of the IOFB and attention to concomitant ocular damage.
• If there is any anticipated delay in surgical intervention, antibiotic prophylaxis should be administered as soon as possible.
• Topical antibiotics are used to provide broad-spectrum coverage. Intraoperatively, 0.1 ml each of intravitreal vancomycin (1 mg/ml) and ceftazidime (2.25 mg/ml) should be administered.
• 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.
• Broad-spectrum intravenous therapy (vancomycin, ancef, ceftazidime and/or newer generation fluoroquinolones) or oral fourth-generation fluoroquinolones (moxifloxacin) are generally acceptable choices.

Ciprofloxacin Oral VS IV

• In general, systemic ciprofloxacin should not be relied upon as a sole prophylactic agent before ocular surgery or in the treatment of suspected intraocular infections.
• However, the results from the present study indicate that an appropriate oral dose of ciprofloxacin may still be a useful adjunct for ocular therapy and prophylaxis.
• 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.  
• If ciprofloxacin is used for ocular surgical prophylaxis, we recommend administration of at least two 750-mg tablets 12 h preoperatively.Surgery could commence at any time within 12 h after administration of the second dose.
• Using oral as well as topical treatment may be a beneficial method of antibiotic prophylaxis in ocular trauma once a patient has received intravenous or intravitreal therapy.

IV & Oral Ciprofloxacin Bioequivalence

• An infusion of 200 mg CIPRO given every 12 hours produces an AUC equivalent to that produced by a 250-mg oral dose given every 12 hours

References:

1. http://www.aao.org/eyenet/article/management-of-intraocular-foreign-bodies
2. http://www.retinalphysician.com/articleviewer.aspx
3. http://www.ncbi.nlm.nih.gov/pubmed/10380027
4. http://www.ncbi.nlm.nih.gov/pubmed/8909207