University of Pennsylvania Medical Center Guidelines for Antibiotic Use

 

OCULAR INFECTIONS

Clinical Setting Empiric Treatment Likely Pathogens Definitive Treatment Dosage Regimen Duration
Endophthalmitis
Post-operative1 ceftazidime + vancomycin2 S. aureus TMP/SMX3 + vancomycin (intravitreous) 8-10mg/kg/d TMP IV in 3-4 divided doses Depends on clinical setting
coagulase negative staphylococcus vancomycin + vancomycin (intravitreous) see this link Depends on clinical setting
P. acnes TMP/SMX3 8-10mg/kg/d TMP,IV in 3-4 divided doses Depends on clinical setting
P. aeruginosa (rarely) levofloxacin + gentamicin (intravitreous) 500mg IV q 24hour Depends on clinical setting
Hematogenous (i.e. SBE)

see endocarditis section

(intravitreous antibiotics may be useful)

Orbital Cellulitis ampicillin/sulbactam +/- vancomycin 4,5 S. aureus cefazolin6 500mg IV q 8 hour Depends on clinical setting
Streptococcus spp. cefazolin6 as above Depends on clinical setting
Enterobacteriaceae TMP/SMX6 8-10mg/kg/d TMP IV in 3-4 divided doses Depends on clinical setting
H. influenzae TMP/SMX6 as above Depends on clinical setting

1Vitrectomy may be required

2Dosage Regimens: ceftazidime 1 gm IV q 8 hour, vancomycin-see Table V

3Achieves superior intra-ocular penetration

4Dosage regimens: ampicillin/sulbactam 1.5-3 gm IV q 6, vancomycin-see Table V

5Requires broad coverage until cavernous sinus thrombosis, orbital apex syndrome, and sinusitis ruled out

6Decongestants may be an important adjunct to therapy when sinusitis present

updated 4/1/2003

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