Intraocular Ceftazidime as an Alternative to the Aminoglycosides in the Treatment of Endophthalmitis

Approximately 85% of bacterial endophthalmitis cases are caused by gram-positive organisms, and treatment with intraocular vancomycin hydrochloride offers excellent coverage with a relatively low potential for retinal toxic effects. The antibiotic of choice for gram-negative coverage remains controversial because of the reported infrequent cases of macular infarction after intraocular administration of either gentamicin sulfate or amikacin sulfate.1 See also pages 45 and 48 Ceftazidime is a third-generation cephalosporin with broad spectrum activity and particularly good coverage of gram-negative bacteria.2Furthermore, its antipseudomonal activity gives it an advantage over other third-generation cephalosporins.2Its use as an intraocular antibiotic has been recently investigated.3We report the results of 13 cultureproven cases of microbial endophthalmitis treated with a combination of intraocular ceftazidime (2.25 mg), vancomycin hydrochloride (1 mg), and dexamethasone sodium phosphate (0.4 mg) via separate syringes (Table). Report of Cases. Of the 13 cases of microbial endophthalmitis, six