Purpose
To determine the ocular toxicity of intravitreally injected daptomycin, a novel antibiotic for treatment of vancomycin-resistant organisms, and its efficacy in treating intraocular infection with coagulase-negative Staphylococcus epidermidis.
Methods
Toxicity study: Four doses of intravitreal daptomycin were injected (75, 188, 375 and 750 micrograms) into one eye of Dutch belted rabbits (n=3 per dose). Clinical examination, electroretinography (ERG) and histologic analysis was performed pre-injection and two-weeks after injection and compared to the fellow eye that received only intravitreal balanced salt solution. Efficacy study: Experimental S. epidermidis endophthalmitis was induced in Dutch belted rabbits (n=24) and the ability of 200 micrograms of intravitreal daptomycin to result in culture-negative vitreous samples was measured at 24 and 48 hours.
Results
Toxicity: 75 and 188 micrograms of daptomycin demonstrated acceptable safety profiles when injected intravitreally in Dutch belted rabbits. There was a dose-dependent increase in cataract formation, ERG suppression and photoreceptor damage with higher doses. Efficacy: 200 micrograms of intravitreal daptomycin resulted in near complete vitreous sterilization 24 hours following treatment. Vitreous sterilization was complete by 48 hours.
Conclusions
A dose of 200 micrograms of intravitreal daptomycin appears to be safe and efficacious in a rabbit model of bacterial endophthalmitis. Future investigations should focus ondaptomycin as a therapeutic option for treating intraocular infection caused by vancomycin-resistant organisms.