Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis

Research output: Contribution to journalArticleResearchpeer-review

Abstract

PURPOSE: To study intravitreal dexamethasone and vancomycin concentrations, when used together in patients with suspected postoperative bacterial endophthalmitis. Animal studies had suggested that dexamethasone might decrease the concentration of vancomycin.

DESIGN: Prospective randomized clinical trial in a tertiary referral center.

METHODS: Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin, 0.05 mg gentamicin) and 400 mug dexamethasone or placebo. After 3-4 days, the intravitreal injection of antibiotics and dexamethasone or placebo was repeated. In 18 patients, a second biopsy was taken for repeat culture and measurement of vancomycin and dexamethasone concentrations.

RESULTS: In 20/29 patients (69%) the first vitreous cultures were positive; the second culture was negative in all cases. Thirteen out of 29 patients received dexamethasone. Dexamethasone concentrations showed an average of 25 ng/ml 3 days after injection, with an estimated half-life of 5.5 h. Vancomycin concentrations in patients given dexamethasone tended to be higher compared with those in the placebo group (P=0.061).

CONCLUSION: Intravitreal dexamethasone does not lead to decreased vancomycin concentrations, when given simultaneously in the treatment of patients with suspected bacterial endophthalmitis.

Original languageEnglish
Pages (from-to)1186-9
Number of pages4
JournalGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
Volume243
Issue number11
DOIs
Publication statusPublished - Nov 2005

Keywords

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents/pharmacokinetics
  • Biological Availability
  • Dexamethasone/pharmacology
  • Endophthalmitis/drug therapy
  • Eye Infections, Bacterial/drug therapy
  • Female
  • Glucocorticoids/pharmacology
  • Half-Life
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prospective Studies
  • Vancomycin/pharmacokinetics
  • Vitreous Body/metabolism

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