Do You Still Use Topical Antibiotics after Intravitreal Injections?

Treatment of wet age-related macular degeneration (AMD) requires frequent intravitreal injections of anti-VEGF agents, sometimes on monthly basis during a long period of time. Endophthalmitis is a rare but extremely severe complication of intravitreal injections. As it has been proven before, the flora from the conjunctival surface is the main source for endophthalmitis. Using Povidone-iodine solution (Betadine10 % Povidone-iodine, EGIS PHARMACEUTICALS) is the only way to prevent endophthalmitis. The efficacy of it was proven by numerous studies. No evidence exists that topical antibiotiotics prior and after injections could be effective for prevention of endophthalmitis. Purpose: To study the advisability of topical antibiotic application before intravitreal injection. Materials and methods: Under investigation, there were 25 eyes of 25 patients with wet AMD treated by anti-VEGF intravitreal injections. All patients used topical antibiotics 3 days before injection. Conjunctival culture from injection eye was collected three times: before topical antibiotic use; after topical antibiotic use, and after Betadine 5 % application. Results: The rates of Staphylococcus epidermidis before and after topical antibiotic use were approximately equal. However there was no Staphylococcus epidermidis found after Betadine 5 % application. Conclusion: Our study showed the effectiveness of Betadine 5 % solution in conjunctival flora reduction. Use of topical antibiotics 3 days prior intravitreal injections is not effective. Key words: age-related macular degeneration; endophthalmitis; intravitreal injection; topical antibiotics; endophthalmitis prevention.

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Is there a rational for the use of topical antibiotics before and after intravitreal injections

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2012.3412.x ◽

2012 ◽

Vol 90 ◽

pp. 0-0

Author(s):

M LABETOULLE

Keyword(s):

Intravitreal Injections ◽

Topical Antibiotics ◽

Before And After

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Controversies in Topical Antibiotics Use with Intravitreal Injections

Current Pharmaceutical Design ◽

10.2174/1381612821666150909101045 ◽

2015 ◽

Vol 21 (32) ◽

pp. 4703-4706 ◽

Cited By ~ 9

Author(s):

Stephen Schwartz ◽

Harry Flynn ◽

Andrzej Grzybowski

Keyword(s):

Intravitreal Injections ◽

Topical Antibiotics ◽

Antibiotics Use

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Faculty Opinions recommendation of Is the use of topical antibiotics for intravitreal injections the standard of care or are we better off without antibiotics?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718042827.793480825 ◽

2013 ◽

Author(s):

Karl Stonecipher

Keyword(s):

Standard Of Care ◽

Intravitreal Injections ◽

Topical Antibiotics

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Incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis

European Journal of Ophthalmology ◽

10.1177/1120672120902028 ◽

2020 ◽

pp. 112067212090202 ◽

Cited By ~ 2

Author(s):

Sónia Torres-Costa ◽

Diogo Ramos ◽

Elisete Brandão ◽

Ângela Carneiro ◽

Vítor Rosas ◽

...

Keyword(s):

Confidence Interval ◽

Antibiotic Prophylaxis ◽

Incidence Rate ◽

Intravitreal Injection ◽

Incidence Rates ◽

Intravitreal Injections ◽

Topical Antibiotic ◽

Retrospective Case ◽

Topical Antibiotics ◽

Number Of Patients

Purpose: The purpose was to compare the incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis. Methods: This is a single-center, retrospective case–control study. All patients treated with intravitreal injection of ranibizumab, bevacizumab, aflibercept, or corticosteroids for a variety of retinal vascular diseases between 1 October 2014 and 30 November 2018 were included. The total number of patients and injections were determined from a review of billing code and practice management records. Endophthalmitis cases were determined from billing records and then confirmed with chart review. A 24-month period when topical antibiotics were prescribed after intravitreal injection was compared with a 24-month period when topical antibiotics were not prescribed. Results: Between 1 October 2014 and 30 November 2018, a total of 33,515 intravitreal injections were performed and 13 cases of post–intravitreal injection endophthalmitis were identified (incidence rate of 0.0388%; 95% confidence interval, 0.0217%–0.0644%) or approximately 1 case for every 2578 intravitreal injections. Between 1 October 2014 and 31 October 2016, while topical antibiotic prophylaxis was used postoperatively, 14,828 intravitreal injections were performed and 5 cases of endophthalmitis were reported (0.0337%; 95% confidence interval, 0.0129%–0.0739%). Between 1 November 2016 and 30 November 2018, while no prophylaxis was used, 18,687 intravitreal injections were performed and 8 cases of endophthalmitis were identified (0.0428%; 95% confidence interval, 0.0202%–0.0808%). There were no statistical differences in the incidence rates between the two groups ( p = 0.675). Conclusion: The incidence rate of endophthalmitis in the group with topical antibiotic prophylaxis after intravitreal injection was similar to the group with no prophylaxis. Changing the current clinical practice to no antibiotic prophylaxis had no effect on the incidence of endophthalmitis.

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Development of Botanical Based Topical Antibiotics

Planta Medica ◽

10.1055/s-0033-1348724 ◽

2013 ◽

Vol 79 (10) ◽

Author(s):

KP Manfredi ◽

M Walter ◽

C Pitzen

Keyword(s):

Topical Antibiotics

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Effects of periodontal therapy with topical antibiotics in the glycemic control of diabetic patients: systematic review.

Revista Estomatología ◽

10.25100/re.v27i1.8735 ◽

2019 ◽

Vol 27 (1) ◽

pp. 31-42

Author(s):

Gloria Cristina Aranzazu-Moya

Keyword(s):

Periodontal Disease ◽

Periodontal Therapy ◽

Periodontal Treatment ◽

Diabetic Patients ◽

Inclusion Criteria ◽

Topical Antibiotics ◽

Bias Risk ◽

Black Scale ◽

Glycated Hemoglobin A ◽

Modest Reduction

Background: Periodontal disease is considered as a diabetes complication and has been suggested that periodontal treatment plus antibiotics should reduce glycated hemoglobin A, by reducing local production of pro inflammatory substances. Objective: To evaluate diabetic patients with periodontal disease under periodontal treatment plus topical antibiotics and reduction of HbA1c, compared to diabetic patients under periodontal treatment without antibiotics. Materials and Methods: Using PUBMED, SCOPUS, WEB OF SCIENCE, EMBASE and Google Scholar data bases, were screened documents from 2008 to 2018. The documents included were the clinical studies, which included non-surgical periodontal treatment plus topical antibiotics, whose outcomes included the HbA1c report. Two independent researchers evaluate title; abstract and bias risk with Downs Black scale and Cochrane tool. Documents with a score higher than 15 on average by the two evaluators were included. Results: Five articles, which find inclusion criteria, were identified. Two documents failed to demonstrate statistically significant effect when compared to non-surgical periodontal therapy alone. Conclusion: In general a modest reduction of HbA1c was identified when using antibiotic therapy.

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