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Post-traumatic endophthalmitis prophylaxis: a systematic review and meta-analysis
Joshua M Van Swol1, Walter K Myers2, Jonathan A Beall3
1College of Medicine, Medical University of South Carolina, Charleston, SC, USA. jmv201@musc.edu.
Journal of Ophthalmic Inflammation and Infection
|November 17, 2022
Summary
Endophthalmitis prophylaxis strategies involving antibiotic treatment longer than 24 hours or non-oral administration showed no significant benefit. Ciprofloxacin monotherapy is linked to worse outcomes in open globe injuries.
Area of Science:
- Ophthalmology
- Infectious Disease
- Pharmacology
Background:
- Endophthalmitis remains a serious risk after ocular procedures.
- Optimizing prophylaxis strategies is crucial for preventing post-operative infections.
- Current prophylaxis guidelines vary, necessitating evidence-based evaluation.
Purpose of the Study:
- To systematically review and meta-analyze endophthalmitis prophylaxis strategies.
- To determine if specific prophylaxis aspects, such as duration, administration route, and antibiotic regimen, impact outcomes.
- To identify superior prophylaxis methods for reducing endophthalmitis rates.
Main Methods:
- Systematic review and meta-analysis of relevant studies.
- Inclusion of studies detailing prophylaxis strategies and endophthalmitis rates.
- Meta-regression analysis incorporating time course, administration method, antibiotic regimen, and confounding factors.
Main Results:
- Prophylaxis duration exceeding 24 hours did not significantly improve outcomes.
- Intraocular or intravenous antibiotic administration showed no significant advantage over oral administration.
- Most antibiotic regimens performed similarly to vancomycin/≥3rd generation cephalosporin, except for ciprofloxacin monotherapy, which resulted in significantly worse outcomes.
Conclusions:
- Future endophthalmitis prophylaxis strategies should carefully weigh the risks and benefits of prolonged antibiotic treatment (>24 hours) and non-oral administration routes.
- Ciprofloxacin monotherapy should be used with caution for endophthalmitis prophylaxis, particularly in cases of open globe injuries, due to poorer outcomes.
- Evidence supports optimizing antibiotic prophylaxis duration and administration for improved patient safety and reduced infection rates.
