Abstract:Topical moxifloxacin was well absorbed. Maximum moxifloxacin concentrations were approximately 30 times higher than the median MICs for common pathogens in bacterial endophthalmitis, indicating that either regimen may provide sufficient concentrations to prevent postoperative endophthalmitis.
“…45 Results in animal and human studies evaluating penetration into the tear film, aqueous humor, cornea, iris-ciliary body, and conjunctiva after topical antibiotic administration show that compared with other ophthalmic fluoroquinolones, moxifloxacin offers superior ocular bioavailability. [46][47][48][49][50][51][52][53][54] This benefit of moxifloxacin can be partly attributed to its 0.5% concentration, which is higher than the concentrations of gatifloxacin, ciprofloxacin, and ofloxacin in their commercially available formulations. Moxifloxacin also has a unique molecular structure that confers it with the desirable combination of high lipophilicity, which enhances corneal penetration, as well as high aqueous solubility, which drives corneal penetration by increasing the concentration gradient at the tear film-corneal epithelial interface.…”
To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.
“…45 Results in animal and human studies evaluating penetration into the tear film, aqueous humor, cornea, iris-ciliary body, and conjunctiva after topical antibiotic administration show that compared with other ophthalmic fluoroquinolones, moxifloxacin offers superior ocular bioavailability. [46][47][48][49][50][51][52][53][54] This benefit of moxifloxacin can be partly attributed to its 0.5% concentration, which is higher than the concentrations of gatifloxacin, ciprofloxacin, and ofloxacin in their commercially available formulations. Moxifloxacin also has a unique molecular structure that confers it with the desirable combination of high lipophilicity, which enhances corneal penetration, as well as high aqueous solubility, which drives corneal penetration by increasing the concentration gradient at the tear film-corneal epithelial interface.…”
To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.
“…Literature in support of the use of topical preoperative prophylaxis have shown a reduction in the number of ocular surface flora [18,19], and achievement of therapeutic intraocular concentrations of antibiotics, especially newer fourth-generation fluoroquinolones such as moxifloxacin and gatifloxacin [20,21]. Nevertheless, in Singapore, a variety of topical preoperative antibiotics were used, including tobramycin, a bactericidal aminoglycoside, the bacteriostatic chloramphenicol, and levofloxacin and moxifloxacin.…”
To determine practice preference of prophylaxis against post-cataract surgery endophthalmitis in Singapore. Prospective nationwide survey of all registered ophthalmologists through telephone, e-mail or postal questionnaires. A response rate of 76.6% was obtained from 121 out of 158 eligible ophthalmologists. Awareness of the recommendations made by the European Society of Cataract and refractive surgeons (ESCRS) endophthalmitis study was noticed in 98 (81.0%) respondents. Out of the 121 respondents, 85 (70.2%) do not use intracameral antibiotic prophylaxis. Of the 36 respondents using intracameral antibiotics, 34 (94.4%) used cefazolin. The reasons cited for not adopting intracameral antibiotic prophylaxis included financial costs, the relatively low risk of endophthalmitis after cataract surgery, the burden of dilution and the fear of toxic anterior segment syndrome. More than half (65, 53.7%) of respondents would use intracameral antibiotic prophylaxis if it were available commercially. The most commonly practiced prophylaxis (94, 77.7%) was preoperative topical antibiotics. The majority of ophthalmologists in Singapore have not adopted the use of intracameral antibiotics, with most preferring the use of pre- and postoperative prophylactic topical antibiotics, despite knowledge of the ESCRS endophthalmitis study.
“…15,[17][18][19] Moxifloxacin 0.5% is a fourth-generation fluoroquinolone that can be used to prevent and treat cataract surgery-associated endophthalmitis. [12][13][14]20 The in vivo effectiveness of moxifloxacin on various S aureus strains in several experimental ocular models has been well described in the literature. [20][21][22] Besifloxacin 0.6% is a new fluoroquinolone that appears to have favorable in vitro activity against ocular pathogens including S aureus.…”
mentioning
confidence: 99%
“…The capabilities of antibiotic agents in the anterior chamber were estimated based on the drug concentrations in the aqueous humor or by clinical extrapolations. [12][13][14][15] Recently, a model of infection in the rabbit was established in which a unique S aureus isolate survived and grew within the anterior chamber. 16 Through the use of this anterior chamber infection model, in vivo antibiotic penetration and effectiveness can be quantitatively measured and thus supply data that can be correlated with previous drug kinetic studies and clinical data.…”
Moxifloxacin had greater in vivo effectiveness against MSSA and MRSA than besifloxacin. The aqueous antibiotic concentrations suggest limited penetration by besifloxacin, accounting for its lack of effectiveness.
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