| EMPIRIC
ANTIINFECTIVE THERAPY IN OPHTHALMOLOGY |
| Initial
selection suggestions. Appropriate cultures with susceptibility
testing must be done to allow proper modification of therapy. |
| Condition |
Common
Organisms |
Selection |
Alternate |
| Blepharitis |
Staphylococci
aureus Staphylococci epidermidis |
bacitracin |
erythromycin |
| Cat
Scratch Disease |
Bartonella henselae |
ciprofloxacin,
oral |
Trimethoprim/Sulfamethoxazole
|
| Cellulitis,
orbital |
Staphylococci
aureus Group A Streptococci Enterobacteriae Haemophilus influenzae
(children)
anaerobes |
nafcillin
or Ancef or vancomycin
plus ceftriaxone
plus clindamycin
|
2nd cephalosporin
and vancomycin or timentin
TMP/SMX
(bactrim)
|
| Cellulitis,
preseptal |
Mild
Moderate-severe |
augmentin
(amox/clav) Oral
ceftriaxone and vancomycin |
TMP/SMX
(bactrim)
unasyn (ampicillin/sulbact) IV/IM
|
| Conjunctivitis,
adult |
chlamydia |
doxycycline |
azithromycin or ofloxacin |
Conjunctivitis
(adult or child) |
St.
pneumoniae Haemophilus influenzae |
neomycin-polymyxin
or fluoroquinolone |
polymyxin-trimethoprim
|
| Conjunctivitis,
viral |
adenovirus |
None |
(NSAIDS)
|
| Conjunctivitis
(Neonatal) |
chlamydia
Neisseria gonorrhea S.aureus , St. pneumo |
erythromycin,
oral
ceftriaxone 125 mg |
|
| Dacryoadenitis |
S. aureus, viral (mumps) |
Oral cephalexin |
erythromycin
|
Dacryocystitis
(children) |
Haemophilus
influenzae |
augmentin (AM/CL) |
TMP/SMX |
Dacrtocystitis
(adult) |
St. pneumo, S. aureus |
Oral cephalexin |
erythromycin
|
| Endophthalmitis
(postsurgical) |
S.
epidermidis
S. aureus
St. species, gram-negatives |
intravitreal
amikacin 400 mcg & vancomycin 1.0 mg |
ceftazidime
2.25 mg & vancomycin 1.0 mg or clindamycin 1.0 mg or cefazolin
2.25 mg
|
Endophthalmitis
(traumatic) |
S.
epi, S. aureus Streptococci species Bacillus species |
intravitreal
amikacin 400 mcg
vancomycin 1.0 mg |
ceftazidime
2.25 mg & vancomycin 1.0 mg or clindamycin 1.0 mg
or cefazolin 2.25 mg |
Endophthalmitis
(post filter surg) |
Streptococci
species Haemophilus influenzae |
intravitreal
amikacin 400 mcg
vancomycin 1.0 mg |
ceftazidime
2.25 mg & vancomycin 1.0 mg or clindamycin 2.25 mg
or cefazolin 2.25 mg
|
Keratitis
Bacterial |
mild
moderate/severe |
ciprofloxacin
ciprofloxacin & cefazolin |
ciprofloxacin
& cefazolin
tobramycin & vancomycin
|
Keratitis
Fungal |
Yeast-Candida
mold-aspergillus |
Natamycin 5% |
amphotericin
0.15%
fluconazole 0.2%
|
Keratitis
Viral |
Herpes
simplex
Herpes zoster |
viroptic
acyclovir, valcyclovir |
acyclovir,
vidarabine
famciclovir, gangciclovir
|
Keratitis
Amebic |
acanthamoeba |
PHMB
0.02% &Brolene PHMB 0.02% & Desmomodine |
chlorhexidine
0.02% & Brolene
Humatin, Itraconzole
|
Prophylaxis
Cataract |
S.
epi, S. aureus
Strep, Gram negatives |
povidone
iodine
topical fluoroquinolone |
cefazolin
subconjunctival
|
Prophylaxis
Intraocular trauma |
S.
epi, S. aureus
Strep, Bacillus, fungus |
topical
fluoroquinolone
IV aminoglycoside and cefazolin |
vancomycin
or clindamycin and
amikacin or ceftazidime
|
