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The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective.
Ophthalmol Ther. 2020 Sep; 9(3):485-498.OT

Abstract

BACKGROUND

The optimal management of patients with endophthalmitis is challenging and includes both intravitreal and, in some cases, systemic antimicrobials. Systemic antimicrobials may be administered either intravenously or orally. In this article we review systemic antimicrobial options currently available for the treatment of types of endophthalmitis and the role of systemic antimicrobials (antibiotics and antifungals) in these treatments.

REVIEW

While systemic antimicrobials are not universally utilized in the management of endophthalmitis, they may be helpful in some circumstances. The blood-retinal barrier affects the penetration of systemic medications into the posterior segment of the eye differently; for example, moxifloxacin and imipenem cross the blood-retinal barrier relatively easily while vancomycin and amikacin do not. However, inflammation, including endophthalmitis, may disrupt the blood-retinal barrier, enhancing the penetration of systemic agents into the eye.

CONCLUSION

Systemic antimicrobials may be particularly beneficial in patients with certain types of endophthalmitis; as such, they are standard treatment in the management of endogenous endophthalmitis (fungal and bacterial) and also widely used for prophylaxis and treatment of open-globe injuries. Although systemic antimicrobials are used in some patients with acute-onset postoperative endophthalmitis following cataract surgery, the literature generally does not support this practice. It is noted that there are currently no randomized clinical trials demonstrating a benefit of systemic antibiotics for any category of endophthalmitis.

Authors+Show Affiliations

Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland. Institute for Research in Ophthalmology, Poznan, Poland.Department of Ophthalmology, Stefan Żeromski Specialist Municipal Hospital, Cracow, Poland.Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA. hflynn@med.miami.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32613591

Citation

Grzybowski, Andrzej, et al. "The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: a Review and an International Perspective." Ophthalmology and Therapy, vol. 9, no. 3, 2020, pp. 485-498.
Grzybowski A, Turczynowska M, Schwartz SG, et al. The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective. Ophthalmol Ther. 2020;9(3):485-498.
Grzybowski, A., Turczynowska, M., Schwartz, S. G., Relhan, N., & Flynn, H. W. (2020). The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective. Ophthalmology and Therapy, 9(3), 485-498. https://doi.org/10.1007/s40123-020-00270-w
Grzybowski A, et al. The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: a Review and an International Perspective. Ophthalmol Ther. 2020;9(3):485-498. PubMed PMID: 32613591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective. AU - Grzybowski,Andrzej, AU - Turczynowska,Magdalena, AU - Schwartz,Stephen G, AU - Relhan,Nidhi, AU - Flynn,Harry W,Jr Y1 - 2020/07/01/ PY - 2020/02/05/received PY - 2020/7/3/pubmed PY - 2020/7/3/medline PY - 2020/7/3/entrez KW - Endogenous endophthalmitis KW - Endophthalmitis KW - Systemic antimicrobials KW - Systemic side-effects SP - 485 EP - 498 JF - Ophthalmology and therapy JO - Ophthalmol Ther VL - 9 IS - 3 N2 - BACKGROUND: The optimal management of patients with endophthalmitis is challenging and includes both intravitreal and, in some cases, systemic antimicrobials. Systemic antimicrobials may be administered either intravenously or orally. In this article we review systemic antimicrobial options currently available for the treatment of types of endophthalmitis and the role of systemic antimicrobials (antibiotics and antifungals) in these treatments. REVIEW: While systemic antimicrobials are not universally utilized in the management of endophthalmitis, they may be helpful in some circumstances. The blood-retinal barrier affects the penetration of systemic medications into the posterior segment of the eye differently; for example, moxifloxacin and imipenem cross the blood-retinal barrier relatively easily while vancomycin and amikacin do not. However, inflammation, including endophthalmitis, may disrupt the blood-retinal barrier, enhancing the penetration of systemic agents into the eye. CONCLUSION: Systemic antimicrobials may be particularly beneficial in patients with certain types of endophthalmitis; as such, they are standard treatment in the management of endogenous endophthalmitis (fungal and bacterial) and also widely used for prophylaxis and treatment of open-globe injuries. Although systemic antimicrobials are used in some patients with acute-onset postoperative endophthalmitis following cataract surgery, the literature generally does not support this practice. It is noted that there are currently no randomized clinical trials demonstrating a benefit of systemic antibiotics for any category of endophthalmitis. SN - 2193-8245 UR - https://www.unboundmedicine.com/medline/citation/32613591/The_Role_of_Systemic_Antimicrobials_in_the_Treatment_of_Endophthalmitis:_A_Review_and_an_International_Perspective L2 - https://dx.doi.org/10.1007/s40123-020-00270-w DB - PRIME DP - Unbound Medicine ER -
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