Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics.

Brockhaus, Lisa; Goldblum, David; Eggenschwiler, Laura; Zimmerli, Stefan; Marzolini, Catia (2019). Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics. Clinical microbiology and infection, 25(11), pp. 1364-1369. Elsevier 10.1016/j.cmi.2019.01.017

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BACKGROUND Adjunctive systemic antibiotic therapy for treatment of bacterial endophthalmitis is controversial but common practice due to the severity of the disease. In absence of guidance documents, several antibiotic regimens are being used without applying evidence-based prescribing, thus leading to inappropriate treatment of this serious eye condition. OBJECTIVES To summarize available data on intravitreal penetration of systemically administered antibiotics and to discuss their usefulness from a microbiological and pharmacological point of view. SOURCES We performed a systematic PubMed search of studies investigating antibiotic concentrations in the vitreous after systemic administration in humans, and selected animal models. CONTENT The best-documented agents achieving therapeutic levels in the vitreous are meropenem, linezolid and moxifloxacin. Vancomycin, cefazoline, ceftriaxone, ceftazidime, imipenem and trimethoprim-sulfamethoxazole reach levels justifying their use in specific situations. Available data do not support the use of ciprofloxacin, levofloxacin, aminoglycosides, aminopenicillins, piperacillin, cefepime, and clarithromycin. With very limited but available promising data, the use of daptomycin and rifampicin deserves further investigation. IMPLICATIONS The choice of the adjunctive systemic antibiotic agent - in situations where considered relevant for treatment - must to date be made on an individual base, considering microbiological aspects as well as operative status and inflammation of the eye. This review gives a systematic overview of antibiotic options and provides guidance to the clinician striving for optimal systemic antibiotic treatment of bacterial endophthalmitis.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Zimmerli, Stefan


600 Technology > 610 Medicine & health








Annelies Luginbühl

Date Deposited:

25 Apr 2019 15:49

Last Modified:

28 Oct 2019 01:31

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Endophthalmitis blood-retinal barrier intravitreal penetration systemic antibiotic vitreous concentration




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