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Update your skills in antibiotic use; here are some guidelines for comanaging cataract and refractive surgery patients.(Therapeutic Review)
Editor's note: This month we welcome Dr. Pewitt as our "Therapeutic Review" columnist. Dr. Pewitt practices with the Veterans Affairs Healthcare System in San Diego.
As comanaging doctors for cataract and refractive surgery, optometrists must be skilled in the use of topical antibiotics to prevent infections, treat those that occur and avoid overtreating. Here, we'll offer some guidelines for comanaging patients.
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Cataract Patients
The incidence of ocular infection following cataract surgery ranges from 0.05% to 0.5%. (1) About 85% of bacterial endophthalmitis isolates are Gram-positive, and 15% are Gram-negative. (2), (3) The most commonly isolated organisms are coagulase-negative Staphylococci (CNS) and Staphylococcus aureus. Less common isolates are Corynebacterium acnes, Micrococcus species, and Gram-negative rods including Pseudomonas aeruginosa. (4)
The optimal characteristics of antibiotics used for perioperative endophthalmitis prophylaxis include the ability to kill bacteria and broad-spectrum coverage, particularly for Gram-positive bacteria. Common medications used include:
* Aminoglycosides. Frequently used aminoglycosides include neomycin, amikacin, gentamicin and tobramycin. Recent studies show that we can effectively treat Gram-positive organisms with neomycin and amikacin, but there are increasing rates of resistance to gentamicin and tobramycin, possibly due to more frequent and widespread use. (5)
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