—We thank Drs Haimann, Weiss, and Miller for their interest in the reasons for specific antibiotic choices in the Endophthalmitis Vitrectomy Study (EVS). Several considerations are important in choosing antimicrobial agents for endophthalmitis. To select the drugs for intravitreal administration, one must weigh the toxicity of the drug in the eye, the ability to achieve bactericidal levels, the antibacterial spectrum, and the drug's half-life. However, for systemically administered antibiotics, one must also consider the systemic toxicity of the drug and the degree to which it penetrates into the vitreous cavity. Even when the antibacterial spectrum is excellent, if a drug administered systemically does not penetrate the vitreous cavity it will be of little benefit in treating endophthalmitis.There is currently broad consensus that the intravitreal drugs of choice in the initial treatment of postsurgical endophthalmitis should be amikacin and vancomycin. Amikacin provides a broad spectrum extending to gram-negative
Doft BH, Barza M. Endophthalmitis Vitrectomy Study-Reply. Arch Ophthalmol. 1991;109(8):1061. doi:10.1001/archopht.1991.01080080018009
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