Nagib Du Toit
Division of Ophthalmology, University of Cape Town, South Africa
Title: Prophylactic antibiotic treatment for the prevention of endophthalmitis after open globe injury
Biography
Biography: Nagib Du Toit
Abstract
Background:
Most post-traumatic acute infectious endophthalmitis occurs within a week of open globe trauma, necessitating early antibiotic prophylaxis. There are few randomised studies that demonstrate the benefits of prophylactic antibiotics. This randomised controlled non-inferiority trial was aimed at determining the incidence of post-traumatic endophthalmitis using established intravenous/oral prophylaxis and comparing this to the incidence using oral antibiotics only.
Methods:
All adult patients admitted with open globe injury were included. Those with proven endophthalmitis, those with high-risk features, those who underwent primary evisceration and those allergic to the trial antibiotics were excluded. Patients were randomised to receive either intravenous cefazolin and oral ciprofloxacin or oral ciprofloxacin and oral cefuroxime for three days from admission. Acute endophthalmitis was the primary outcome measure. Patients completed the study if they were followed up for six weeks post-injury.
Results:
Three hundred patients were enrolled, with 150 in each arm. There were 99 exclusions. Seven patients developed endophthalmitis despite prophylaxis - 2.0% (three cases) in the standard arm and 2.7% (four cases) in the oral arm - this difference was not statistically significant (p = 0.703).
Conclusion:
The incidence of endophthalmitis with prophylaxis was 2-3%. Patients who suffer open globe injury should be treated for endophthalmitis if already infected; be eviscerated if warranted by severe injuries; and receive intravitreal injections of prophylactic antibiotics if risk factors for infection are present. The remainder may receive either intravenous cefazolin and oral ciprofloxacin, or oral cefuroxime and oral ciprofloxacin – the latter has the advantage of shortening patients’ hospital stays and reducing costs. Non-inferiority study design limitations should be taken into account, however.