Intravenous administration of Penicillin results in therapeutic intravitreal levels in chronic postoperative endophthalmitis

Abstract

Importance The role of systemic antibiotics in the treatment of bacterial endophthalmitis remains controversial. While penicillin is a highly effective antibiotic against bacteria that frequently cause endophthalmitis, the ability of systemically administered Penicillin G to penetrate into the vitreous at adequate therapeutic concentrations has not been studied. Its role in the treatment of endophthalmitis, particularly for bacteria for which it is the antibiotic of choice, therefore remains unknown. Objective We sought to determine whether intravenous administration of Penicillin G leads to adequate therapeutic concentrations in the vitreous for the treatment of bacterial endophthalmitis. Design and setting This study was conducted in an ambulatory setting, at the Ottawa Hospital Eye Institute, a university-affiliated tertiary care center, where a 77-year old gentleman with chronic post-cataract surgery Actinomyces neuii endophathalmitis was treated with intravenous Penicillin G (4 × 106 units every 4 h) and intravitreal ampicillin (5000μg/0.1 m1). Main outcomes and measures Intravitreal concentration of Penicillin G and ampicillin were obtained at the time of intraocular lens removal, measured by high-performance liquid chromatography. Results The intravitreal concentration of penicillin and ampicillin was 3.5μg/ml and 0.3μg/ml, respectively. Both the concentration of penicillin and ampicillin were within the level of detection of their respective assays (penicillin 0.06-5μg/ml, ampicillin 0.12–2.5μg/ml). Conclusion and relevance This study shows that intravenous Penicillin G administered every four-hours allows for adequate intravitreal concentrations of penicillin. Future studies are required to determine if the results of this study translate into improved clinical outcomes.

Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

“…Fukuda and colleagues reported that dupilumab was effective in treating giant papillae on the palpebral conjunctiva of two patients with atopic keratoconjunctivitis, and as such, they suggested the potential benefits of using dupilumab as an immunobiologic agent in individuals with severe forms of chronic ocular allergy [ 192 ]. However, there have been reports of dupilumab-associated ocular surface disease in patients with atopic dermatitis [ 193 , 194 , 195 , 196 ]. There is currently a multi-center, double-masked, randomized, and placebo-controlled, parallel-group study that is evaluating the safety and efficacy of dupilumab in the treatment of signs and symptoms of individuals with atopic keratoconjunctivitis (NCT04296864).…”

Chronic Pseudophakic Endophthalmitis After Uneventful Phakoemulsification: A Case Series and Review of Litterature

“…We performed an irrigation and washing of the CB, associated to the IOAB, as recommended in some studies (9,12). The use of SATB remains controversial (13,15,21,74,75). The slow growth of most common microorganisms isolated in CPE and their sequestration in the CB justify the need of repeated IOAB injection as we observed in cases n°3, 5, 6.…”

First Report of a Case of Ocular Infection Caused by Purpureocillium lilacinum in Poland

“…Thus, the identification of fungi using conventional techniques generally requires 3–7 days [ 6 ]. To improve identification, the use of molecular biology methods, such as real-time polymerase chain reaction (RT-PCR), for pathogen DNA quantification in specimens, can differentiate between true infection and possible contamination of the anterior chamber by microorganisms present in the conjunctival flora [ 7 , 8 , 9 , 10 ]. Moreover, the results of the PCR identification are available in less than 24 h [ 11 ].…”