Cefazolin as Endophthalmitis Prophylaxis in Cataract Surgery
Cefazolin as Endophthalmitis Prophylaxis in Cataract Surgery
Endophthalmitis remains a serious complication after cataract surgery, although prophylactic measures introduced in recent years have reduced the number of patients with this complication.
Currently there are two streams of opinion towards endophthalmitis prophylaxis, the use of fourth-generation quinolones (gatifloxacin and moxifloxacin) topically, or the introduction of intracameral cephalosporins, the latter being cefuroxime (a second generation cephalosporin), which is the most widely used and accepted. However, our study group, as well as Garat et al, prefers the use of cefazolin (a first generation cephalosporin). Having previously studied the bacteria that cause endophthalmitis in our environment most frequently, we prefer cefazolin because of its higher frequency of gram-positive bacteria in our medium, and because it best covers infections by such bacteria. Furthermore, cefazolin shows no corneal toxicity at doses of 1 mg or 2 mg; its toxicity was established when doses of 5 mg or more were injected. We consider the risk of an infection caused by a cefazolin-resistant bacterium low, based on the bacteria cultured since 1994 and their antibiogram. We consider there not to be any risk of coverage of gram-negative bacteria by cefazolin, and its incidence in endophthalmitis was low in our Health Care District.
Our two groups are included in the Barcelona Endophthalmitis Group (GEB), formed by 38 public and private Hospitals in Catalonia (Spain), who have been studying the epidemiological factors of postoperative endophtalmitis and assessing the prophylaxis and treatment of endophtalmitis in our country since 2000. Appendix 1 gives a list of GEB participating hospitals and ophthalmologists.
This study will present the results obtained after seven years of using intracameral cefazolin after cataract surgery at doses of 1 mg in 0.1 ml.
Background
Endophthalmitis remains a serious complication after cataract surgery, although prophylactic measures introduced in recent years have reduced the number of patients with this complication.
Currently there are two streams of opinion towards endophthalmitis prophylaxis, the use of fourth-generation quinolones (gatifloxacin and moxifloxacin) topically, or the introduction of intracameral cephalosporins, the latter being cefuroxime (a second generation cephalosporin), which is the most widely used and accepted. However, our study group, as well as Garat et al, prefers the use of cefazolin (a first generation cephalosporin). Having previously studied the bacteria that cause endophthalmitis in our environment most frequently, we prefer cefazolin because of its higher frequency of gram-positive bacteria in our medium, and because it best covers infections by such bacteria. Furthermore, cefazolin shows no corneal toxicity at doses of 1 mg or 2 mg; its toxicity was established when doses of 5 mg or more were injected. We consider the risk of an infection caused by a cefazolin-resistant bacterium low, based on the bacteria cultured since 1994 and their antibiogram. We consider there not to be any risk of coverage of gram-negative bacteria by cefazolin, and its incidence in endophthalmitis was low in our Health Care District.
Our two groups are included in the Barcelona Endophthalmitis Group (GEB), formed by 38 public and private Hospitals in Catalonia (Spain), who have been studying the epidemiological factors of postoperative endophtalmitis and assessing the prophylaxis and treatment of endophtalmitis in our country since 2000. Appendix 1 gives a list of GEB participating hospitals and ophthalmologists.
This study will present the results obtained after seven years of using intracameral cefazolin after cataract surgery at doses of 1 mg in 0.1 ml.
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