What is the treatment for endophthalmitis?

From the Guidelines

Endophthalmitis treatment requires immediate intervention with antifungal agents, typically fluconazole or voriconazole, and may necessitate intravitreal injection of antifungal agents, such as AmB deoxycholate or voriconazole, with or without vitrectomy, to prevent permanent vision loss. The treatment approach should be determined by the extent of the infection, including whether the macula or vitreous are involved, and the antifungal susceptibilities of the infecting species 1.

Key Considerations

• The choice of antifungal agent depends on the susceptibility of the infecting species, with fluconazole and voriconazole being preferred options due to their ability to achieve adequate concentrations in the posterior segment of the eye, including the vitreous 1.
• Intravitreal injection of antifungal agents, such as AmB deoxycholate or voriconazole, may be necessary in cases of sight-threatening lesions near the macula or invasion into the vitreous, and should be considered in conjunction with systemic antifungal therapy 1.
• Vitrectomy surgery may be necessary in severe cases to remove infected vitreous and improve antifungal distribution, and should be considered in consultation with an ophthalmologist and an infectious diseases physician 1.
• The duration of therapy should be at least 4-6 weeks or until resolution of the lesions, and should be guided by clinical judgment and monitoring of the patient's response to treatment 1.

Treatment Approach

• Systemic antifungal therapy with fluconazole or voriconazole should be initiated promptly, with dosing regimens guided by the patient's weight and renal function 1.
• Intravitreal injection of antifungal agents, such as AmB deoxycholate or voriconazole, should be considered in cases of sight-threatening lesions near the macula or invasion into the vitreous, and should be performed in conjunction with systemic antifungal therapy 1.
• Vitrectomy surgery should be considered in severe cases, and should be performed in consultation with an ophthalmologist and an infectious diseases physician 1.

From the Research

Treatment Options for Endophthalmitis

• The treatment for endophthalmitis typically involves the use of intravitreal antibiotics, with the goal of preventing severe vision loss 2, 3, 4.
• The choice of antibiotic depends on the type of bacteria causing the infection, with vancomycin being effective against Gram-positive organisms and ceftazidime or amikacin being used against Gram-negative bacteria 3, 4, 5.
• Systemic antibiotic therapy may also be used as an adjunct to intravitreal treatment, with agents such as meropenem, linezolid, and moxifloxacin achieving therapeutic levels in the vitreous 6.
• The use of drug combinations is necessary to cover the full range of bacteria causing endophthalmitis, and the choice of antibiotic should be made on an individual basis considering microbiological aspects as well as operative status and inflammation of the eye 3, 6, 4.

Antibiotic Susceptibility

• Vancomycin is effective against most Gram-positive organisms, including coagulase-negative staphylococci, Streptococci, Enterococci, and Staphylococcus aureus 5.
• Ceftazidime and amikacin provide approximately the same degree of Gram-negative coverage, with 96.9% and 93.7% of Gram-negative isolates being susceptible to these antibiotics, respectively 5.
• Multidrug-resistant bacterial endophthalmitis is uncommon, but may be caused by organisms such as Klebsiella pneumoniae, Acinetobacter baumannii, and Stenotrophomonas maltophilia 5.

Timing and Administration of Treatment

• Early diagnosis and treatment with intravitreal antibiotics are crucial for preventing severe vision loss, with treatment administered within 24 hours of diagnosis providing a relatively favorable visual prognosis 2.
• The intraocular concentration of antibiotics after intravitreous injection is far greater than that achieved by any other modality, making intravitreal injection an effective method of treatment 4.