Topical azithromycin or ofloxacin for endophthalmitis

نویسندگان

  • Michael W Stewart
  • Michael L Stewart
  • Pedro Romero-Aroca
چکیده

Correspondence: Michael W Stewart Department of Ophthalmology, 4500 San Pablo Rd, Jacksonville, FL 32224, USA Tel +1 904 953 2232 Fax +1 904 953 7040 Email [email protected] The recently published study by Romero-Aroca et al raises interesting questions regarding the effect of choice of topical antibiotic (azithromycin versus ofloxacin) on the incidence of endophthalmitis following intravitreal injections. However, important conclusions advanced by the authors deserve further discussion. First, the authors state that use of azithromycin leads to significantly fewer cases of post-injection endophthalmitis than does the use of ofloxacin. Their prospective series shows a lower endophthalmitis rate in eyes treated with azithromycin (two cases in 4045 injections, 0.049%) than in eyes treated with ofloxacin (five cases in 4151 injections, 0.12%). They calculate a relative risk of 2.37, and conclude that this was statistically significant (confidence interval 1.37–3.72; P , 0.001). We believe that this conclusion is wrong because of errors in the statistical computations. When the endophthalmitis incidence rates are compared using both the Chi-square and two-proportion z-tests, the differences between the cohorts are minimal and far from clinically significant (Chi-square 1.211, two-sided z-statistic 1.10; P = 0.27 for both tests). In fact, for these observed rates to yield a significant difference, a trial with 12,000 injections in each group (three times the size reported by the authors) would be necessary. Therefore, with the data presented, it is not possible to detect a meaningful difference in endophthalmitis rates between the two drugs. Contrary to the authors’ assertion, many retrospective and prospective studies have reported the incidence of endophthalmitis after injections. In the largest prospective age-related macular degeneration trials to date (VIEW 1 and 2), six cases of endophthalmitis occurred after 27,112 (0.022% or one in 4519) injections in 2457 patients. This endophthalmitis rate is similar to the rates reported in the two largest published series of injections (one in 4059 patients and the other in 8617 patients). This leads to the second important point, ie, the authors performed their study under the assumption that prophylactic topical antibiotics lower the incidence of post-injection endophthalmitis. However, to date, no studies have shown that use of prophylactic antibiotics lowers the rate of post-injection endophthalmitis. No differences in antibiotic-related endophthalmitis rates were identified in the largest retrospective series, and as a result, many surgeons have abandoned such use of antibiotics. The conclusions advanced by Romero-Aroca et al also have significant financial implications. Recent data show that more than 220,000 patients (2008 Medicare data) in the US receive intravitreal injections each year. Single bottles of azithromycin and ofloxacin cost $108 and $18, respectively, and if these were prescribed once yearly for Dovepress

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Topical azithromycin or ofloxacin for endophthalmitis prophylaxis after intravitreal injection

BACKGROUND The number of patients who have undergone intravitreal injections has increased enormously in recent years, but a consensus is still lacking on prophylaxis for endophthalmitis. The aim of this prospective, observational study was to evaluate the prophylactic effect of azithromycin eye drops versus ofloxacin eye drops. METHODS The study was conducted in five hospitals in Spain and i...

متن کامل

Comparative Effectiveness of Antibiotic Prophylaxis in Cataract Surgery.

PURPOSE Intracameral injection is an effective method for preventing infection, but no controlled study has been published in the United States. DESIGN We conducted an observational, longitudinal cohort study to examine the effect of topical and injected antibiotics on risk of endophthalmitis. PARTICIPANTS We identified 315 246 eligible cataract procedures in 204 515 members of Kaiser Perma...

متن کامل

Short-Term Azithromycin Treatment Promotes Cornea Allograft Survival in the Rat

BACKGROUND Any inflammatory response following corneal transplantation may induce rejection and irreversible graft failure. The purpose of this study is to analyze the anti-inflammatory effect of azithromycin (AZM) following experimental keratoplasty in rats. METHODS Corneal transplants were performed between Fisher-donor and Lewis-recipient rats. Recipients were postoperatively treated three...

متن کامل

A randomised controlled comparison of ofloxacin , azithromycin and an 1 ofloxacin - azithromycin

resistant and nalidixic acid resistant typhoid fever. 3 4 Running title: Azithromycin and ofloxacin in typhoid fever 5 6

متن کامل

Susceptibility of Mycobacterium kansasii to ofloxacin, sparfloxacin, clarithromycin, azithromycin, and fusidic acid.

The MICs of ofloxacin, sparfloxacin, clarithromycin, azithromycin, and fusidic acid for clinical isolates of Mycobacterium kansasii were determined by the radiometric (BACTEC) method. All drugs except azithromycin elicited MICs for 90% of the strains tested that were lower than previously reported achievable maximum concentrations in serum. Ofloxacin, sparfloxacin, and clarithromycin had the la...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 7  شماره 

صفحات  -

تاریخ انتشار 2013