From the Research
The treatment for tube-related endophthalmitis involves immediate and aggressive intervention with intravitreal antibiotics, typically vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) or amikacin (0.4 mg/0.1 mL), as supported by the most recent study on susceptibility of bacterial endophthalmitis isolates to vancomycin, ceftazidime, and amikacin 1.
Key Considerations
- The glaucoma drainage device (tube) should be removed promptly as it serves as a nidus for infection.
- Vitrectomy is often necessary to remove infected vitreous and improve antibiotic distribution.
- Systemic antibiotics such as fluoroquinolones should also be administered, with consideration of the most effective options based on the review of systemic treatment of bacterial endophthalmitis 2.
- Topical fortified antibiotics (e.g., vancomycin 25-50 mg/mL and tobramycin 14 mg/mL) should be applied hourly.
- Anti-inflammatory agents like oral prednisone (1 mg/kg/day) may be added after infection control begins.
Treatment Duration and Adjustments
- Treatment should continue for 7-14 days, with adjustments based on culture results and clinical response.
- Early diagnosis and treatment are crucial as tube-related endophthalmitis is often caused by virulent organisms like Streptococcus or Staphylococcus species that can rapidly destroy ocular tissues, leading to poor visual outcomes if not addressed promptly.
Evidence Base
- The recommendation is based on the most recent and highest quality study available, which provides guidance on the susceptibility of bacterial endophthalmitis isolates to vancomycin, ceftazidime, and amikacin 1.
- Additional evidence from reviews on endophthalmitis treatment and management 3, 4, 5 supports the importance of prompt and aggressive intervention with intravitreal antibiotics and consideration of systemic antibiotics and other treatments as needed.