The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Ocul Pharmacol Ther. 2012 Dec;28(6):604-8. doi: 10.1089/jop.2012.0073. Epub 2012 Aug 27.
Topical antibacterial agents, used as an off-label indication, are frequently administered pre- and postoperatively to prevent endophthalmitis. We compared topical treatment with fluoroquinolone (FQ) anti-infectives to non-FQ antibacterial agents to prevent Staphylococcus aureus endophthalmitis. We hypothesize that FQ anti-infectives are more effective than non-FQ antibacterial agents for preventing endophthalmitis.
Moxifloxacin 0.5%, ofloxacin 0.3%, gentamicin 0.3%, chloramphenicol 0.5%, polymyxin B/trimethoprim (10,000 units/mL/0.1%), povidone-iodine 5%, and saline were tested for topical treatment to prevent endophthalmitis. Topical treatment was applied every 15 min for 1 h (5 drops) to the left eye of 14 rabbits for each antibacterial agent and saline. After appropriate anesthesia, the anterior chambers were injected with 1×10(5) colony-forming units of a clinical endophthalmitis isolate of a S. aureus that was susceptible to all tested antibacterials. One drop was administered immediately and another 4 drops of topical treatment were applied over 24 h after injection. At 24 h postinjection, the eyes were graded for clinical signs of endophthalmitis (ocular discharge, conjunctivitis/scleral injection, limbal injection, hypopyon*, iritis*, anterior chamber cells*, anterior chamber flare*, corneal infiltration, and fibrin production*) using a severity scale (0-3). The indication of clinical endophthalmitis was a total score of >3.0 for the presentations marked with an asterisk. The data were analyzed using Fisher's Exact Randomization or Mann-Whitney nonparametric testing.
Topical ofloxacin (14/14, 100% without endophthalmitis) and moxifloxacin (13/14, 93%) prevented the clinical presentation of endophthalmitis significantly more frequently (P=0.03, Fisher's Exact Test (FE)) than topical gentamicin (7/14, 50%), povidone iodine (4/14, 29%), chloramphenicol (0/14, 0%), polymyxin B/trimethoprim (0/14, 0%), and saline (0/14, 0%). The median total clinical scores for the ofloxacin (0.5) and moxifloxacin (0.8) groups were significantly (P=0.008, Mann-Whitney Test (MW)) lower than gentamicin (5.7), chloramphenicol (17.5), polymyxin B/trimethoprim (21.2), povidone-iodine (15.5), and saline (18.7).
The FQs, ofloxacin and moxifloxacin, were more effective in preventing endophthalmitis than the non-FQ antibacterial agents in a rabbit S. aureus endophthalmitis model. The observed results are consistent with the hypothesis that FQs penetrate into the anterior chamber at more effective levels than many of the common non-FQ antibacterial agents.
局部使用抗菌药物（作为非适应证用药），常用于预防眼内炎。我们比较了氟喹诺酮（FQ）抗感染药物与非 FQ 抗菌药物，以预防金黄色葡萄球菌眼内炎。我们假设 FQ 抗感染药物比非 FQ 抗菌药物更能有效预防眼内炎。
莫西沙星 0.5%、氧氟沙星 0.3%、庆大霉素 0.3%、氯霉素 0.5%、多粘菌素 B/甲氧苄啶（10000 单位/mL/0.1%）、聚维酮碘 5%和生理盐水用于预防眼内炎的局部治疗。每种抗菌药物和生理盐水均以 15 分钟 1 次、1 小时（5 滴）的频率，用于 14 只兔子的左眼。在适当的麻醉下，向左侧前房注入 1×10（5）个临床分离的金黄色葡萄球菌眼内炎分离株的菌落形成单位，该分离株对所有测试的抗菌药物均敏感。注射后立即给予 1 滴，24 小时后再给予 4 滴局部治疗。注射后 24 小时，使用严重程度评分（0-3）对眼部眼内炎的临床体征（眼分泌物、结膜炎/巩膜注射、角膜缘注射、前房积脓*、虹膜炎*、前房细胞*、前房闪光*、角膜浸润和纤维蛋白生成*）进行分级。眼内炎的临床指征为带有星号的表现的总评分>3.0。使用 Fisher 精确随机化或 Mann-Whitney 非参数检验分析数据。
局部应用氧氟沙星（14/14，100%无眼内炎）和莫西沙星（13/14，93%）可显著更频繁地预防眼内炎的临床表现（P=0.03，Fisher 精确检验（FE）），而局部应用庆大霉素（7/14，50%）、聚维酮碘（4/14，29%）、氯霉素（0/14，0%）、多粘菌素 B/甲氧苄啶（0/14，0%）和生理盐水（0/14，0%）的效果较差。氧氟沙星（0.5）和莫西沙星（0.8）组的总临床评分中位数明显（P=0.008，Mann-Whitney 检验（MW））低于庆大霉素（5.7）、氯霉素（17.5）、多粘菌素 B/甲氧苄啶（21.2）、聚维酮碘（15.5）和生理盐水（18.7）。
在金黄色葡萄球菌眼内炎兔模型中，FQ，即氧氟沙星和莫西沙星，比非 FQ 抗菌药物更能有效预防眼内炎。观察到的结果与 FQ 比许多常见的非 FQ 抗菌药物更有效地穿透前房的假设一致。
