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2012 OMIG Abstract 5

The Comparison of Fluoroquinolones to Non-Fluoroquinolone Antibacterial Agents for the Prevention of Endophthalmitis in a Rabbit Model
E.G. Romanowski, F.S. Mah, K A. Yates, R.M.Q. Shanks, L.V. Raju, Y.J. Gordon, R.P. Kowalski
The Charles T. Campbell Ophthalmic Microbiology Laboratory, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA.

Purpose: Topical antibacterial agents, used off-label, are frequently administered pre- and post-operatively to help prevent endophthalmitis. The goal of the current study was to compare topical treatment with fluoroquinolone (FQ) anti-infectives to non-FQ antibacterial agents to prevent Staphylococcus aureus endophthalmitis.

Methods:Topical treatment with moxifloxacin 0.5% (MOX), ofloxacin 0.3% (OFX), gentamicin 0.3% (GENT), chloramphenicol 0.5% (CHL), polymyxin B/trimethoprim 10,000 units/ml/0.1% (PBT), povidone-iodine 5% (PI), and saline (SAL) was tested for the prevention of endophthalmitis. Topical treatment with each antibacterial agent and SAL was applied every 15 min for one hour (5 drops) to the left eye of 14 rabbits after which the anterior chambers were injected with 1 x 10⁵ CFU of a clinical endophthalmitis isolate of a S. aureus that was susceptible to all tested antibacterials. One drop of test agent was administered immediately after injection and another 4 drops were applied over 24 hrs after injection. At 24 hrs post-injection, the eyes were evaluated for clinical signs of endophthalmitis (ocular discharge, conjunctivitis/scleral injection, limbal injection, hypopyon*, iritis*, anterior chamber cells*, anterior chamber flare*, corneal infiltration, and fibrin production*) using a severity scale (0 to 3). The indication of clinical endophthalmitis was a total score of > 3.0 for the presentations marked with an asterisk. The data were analyzed using Fisher’s Exact Randomization or Mann-Whitney non-parametric testing.

Results: Topical OFX (14/14, 100% without endophthalmitis) and MOX (13/14, 93%) prevented the clinical presentation of endophthalmitis significantly more frequently (p=0.03, FE) than GENT (7/14, 50%), PI (4/14, 29%), CHL (0/14, 0%), PBT (0/14, 0%), and saline (0/14, 0%). The median total clinical scores for the OFX (0.5) and MOX (0.8) groups were significantly (p= 0.008, MW) lower than GENT (5.7), CHL (17.5), PBT (21.2), PI (15.5), and SAL (18.7).

Conclusions: The fluoroquinolones, OFX and MOX, were more effective in preventing endophthalmitis than the non-FQ antibacterial agents in a rabbit S. aureus endophthalmitis model. The observed results are consistent with the hypothesis that FQs penetrate into the anterior chamber at more effective levels than many of the common non-FQ antibacterial agents.

Disclosure: S, C      Support: Alcon Laboratories, Fort Worth, TX

2012 Agenda and Abstracts | < Previous | Next >