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Ophthalmology and Therapy

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Open Access 01-09-2020 | Imipenem | Review

The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective

Authors: Andrzej Grzybowski, Magdalena Turczynowska, Stephen G. Schwartz, Nidhi Relhan, Harry W. Flynn Jr.

Published in: Ophthalmology and Therapy | Issue 3/2020

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.

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Title: The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective
Authors: Andrzej Grzybowski
Magdalena Turczynowska
Stephen G. Schwartz
Nidhi Relhan
Harry W. Flynn Jr.
Publication date: 01-09-2020
Publisher: Springer Healthcare
Keywords: Imipenem
Moxifloxacin
Amikacin
Antibiotic
Cataract
Vancomycin
Published in: Ophthalmology and Therapy / Issue 3/2020
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI: https://doi.org/10.1007/s40123-020-00270-w

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