EMPIRIC TREATMENT OF ENDOPHTHALMITIS - ARE AMINOGLYCOSIDES NECESSARY

Objective: To reevaluate the necessity of empiric gramnegative therapy for postoperative endophthalmitis based on the recognition of aminogl ycoside-induced toxic effects. Methods: A review of 162 cases of cultu re-positive bacterial endophthalmitis to determine bacterial prevalenc e, antibiotic susceptibilities, and laboratory staining results of int raocular material. Results: One hundred fifty (93%) gram-positive and 12 (7%) gram-negative isolates. All the gram-positive bacteria were su sceptible 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: Vanco mycin is an appropriate single agent if laboratory studies rule out gr am-negative infection. In the absence of laboratory support, an aminog lycoside (possible toxic effects) or another gram-negative antibiotic (possibly ceftazidime) should also be administered.