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Preoperative antibiotic and povidone-iodine preparation of the eye
S R Grimes1, C E Mein, S Trevino
1Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200.
Abstract:
We compared gentamicin 0.3% one drop every three hours the night before and the morning of surgery ("half-day regimen") with the same drug one drop qid for three days ("three-day regimen") in 15 eyes undergoing intraocular surgery. Conjunctival cultures of both groups taken before povidone-iodine preparation showed mean colony counts of 3.67 +/- 0.82 in the half-day regimen versus 1.0 +/- 0.43 in the three-day regimen. Conjunctival cultures taken after the administration of a povidone-iodine 5% preparation showed 7.17 +/- 3.52 and 2.75 +/- 0.88, respectively, in the two groups. Although there was a statistical difference in colony counts, topical gentamicin 0.3% given the night before and day of surgery had comparable low colony counts with the three-day course. The 5% povidone-iodine solution was not effective in reducing bacterial flora although it did eliminate all fungal colonies.
Insights
A shorter, half-day regimen of topical gentamicin 0.3% for intraocular surgery provided similar low bacterial colony counts compared to a three-day regimen. Povidone-iodine 5% did not effectively reduce bacterial flora but eliminated fungal colonies.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Infections
Background:
- Bacterial contamination poses a risk for intraocular surgery.
- Optimizing perioperative antibiotic regimens is crucial for infection prevention.
- The efficacy of different gentamicin dosing schedules and povidone-iodine preparation requires evaluation.
Purpose of the Study:
- To compare the efficacy of a half-day versus a three-day topical gentamicin regimen in reducing conjunctival bacterial flora before intraocular surgery.
- To assess the impact of 5% povidone-iodine preparation on bacterial and fungal flora in the conjunctiva.
Main Methods:
- A prospective study involving 15 eyes undergoing intraocular surgery.
- Comparison of two gentamicin 0.3% regimens: half-day (pre-op and morning of surgery) versus three-day (four times daily).
- Conjunctival cultures were obtained before and after 5% povidone-iodine preparation.
Main Results:
- While initial colony counts differed statistically between gentamicin groups, the half-day regimen achieved comparable low counts to the three-day regimen post-preparation.
- 5% povidone-iodine preparation did not significantly reduce bacterial flora.
- 5% povidone-iodine effectively eliminated all fungal colonies detected.
Conclusions:
- A half-day topical gentamicin regimen is a viable alternative for reducing bacterial load before intraocular surgery.
- The standard three-day gentamicin regimen may not offer superior bacterial reduction compared to a shorter perioperative course.
- 5% povidone-iodine demonstrates antifungal but not significant antibacterial efficacy in this context.