Intravitreal Daptomycin

Abstract

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.

Vancomycin-resistant Gram-positive bacterial endophthalmitis: epidemiology, treatment options, and outcomes

“…It demonstrates good in vitro bactericidal activity for vancomycin-resistant strains of bacteria accounting for endophthalmitis, including S. epidermidis , S. aureus , S. pneumoniae , E. faecalis , and E. faecium [12]. Comer and colleagues demonstrated that administration of 200 μg of intravitreal daptomycin was safe and efficacious in a rabbit model of bacterial endophthalmitis [13]. Tigecycline is a glycylcycline antibiotic that binds to the 30S ribosomal subunit to inhibit protein synthesis.…”

Emerging Worldwide Antimicrobial Resistance, Antibiotic Stewardship and Alternative Intravitreal Agents for the Treatment of Endophthalmitis

“…47-52 Hernandez-Da Mota et al (2011) and Stroh et al (2012) reported cases of endophthalmitis caused by vancomycin-resistant Staphylococcus aureus which were successfully treated with intravitreal quinupristin/dalfopristin. 47, 48 A literature review showed two case reports (Buzzaco et al, 2012 and Sim et al, 2016) of endophthalmitis caused by vancomycin-resistant gram-positive cocci which resolved completely with the use of intravitreal daptomycin.…”

Modern Aspects of the Treatment of Acute Bacterial Postoperative Endophthalmitis

“…В настоящее время предложены для лечения ванкомицин-резистентных интраокулярных инфекций новые антибиотики, кото-рые обладают высоким профилем безопасности. Однако связанные с этим исследования пока ограничены докли-ническими испытаниями, в которых уже продемонстри-рована их перспективность [32].…”