[Skip to Content]
[Skip to Content Landing]
January 1994

Empiric Treatment of Endophthalmitis: Are Aminoglycosides Necessary?

Author Affiliations

From the Department of Ophthalmology (Drs Donahue, Eller, and DeVaro) and the Charles T. Campbell Laboratory (Mr Kowalski), University of Pittsburgh (Pa) Medical Center, and the Department of Ophthalmology, St Francis Hospital, Pittsburgh (Dr Jewart).

Arch Ophthalmol. 1994;112(1):45-47. doi:10.1001/archopht.1994.01090130055016

Objective:  To reevaluate the necessity of empiric gram-negative therapy for postoperative endophthalmitis based on the recognition of aminoglycoside-induced toxic effects.

Methods:  A review of 162 cases of culture-positive bacterial endophthalmitis to determine bacterial prevalence, antibiotic susceptibilities, and laboratory staining results of intraocular material.

Results:  One hundred fifty (93%) gram-positive and 12 (7%) gram-negative isolates. All the gram-positive bacteria were susceptible to vancomycin hydrochloride; and gram-negative bacteria were susceptible to gentamicin sulfate, amikacin sulfate, and ceftazidime sodium. Bacterial rods were observed on smear of intraocular material in 10 gram-negative cases submitted for examination.

Conclusion:  Vancomycin is an appropriate single agent if laboratory studies rule out gram-negative infection. In the absence of laboratory support, an aminoglycoside (possible toxic effects) or another gram-negative antibiotic (possibly ceftazidime) should also be administered.