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Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis

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Abstract

Purpose

To study intravitreal dexamethasone and vancomycin concentrations, when used together in patients with suspected postoperative bacterial endophthalmitis. Animal studies had suggested that dexamethasone might decrease the concentration of vancomycin.

Design

Prospective randomized clinical trial in a tertiary referral center.

Methods

Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin, 0.05 mg gentamicin) and 400 μg dexamethasone or placebo. After 3–4 days, the intravitreal injection of antibiotics and dexamethasone or placebo was repeated. In 18 patients, a second biopsy was taken for repeat culture and measurement of vancomycin and dexamethasone concentrations.

Results

In 20/29 patients (69%) the first vitreous cultures were positive; the second culture was negative in all cases. Thirteen out of 29 patients received dexamethasone. Dexamethasone concentrations showed an average of 25 ng/ml 3 days after injection, with an estimated half-life of 5.5 h. Vancomycin concentrations in patients given dexamethasone tended to be higher compared with those in the placebo group (P=0.061).

Conclusion

Intravitreal dexamethasone does not lead to decreased vancomycin concentrations, when given simultaneously in the treatment of patients with suspected bacterial endophthalmitis.

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Author information

Authors and Affiliations

  1. The Rotterdam Eye Hospital, PO Box 70030, 3000 LM, Rotterdam, The Netherlands

    Ivan M. Gan, Luana C. Ugahary & Jan C. van Meurs

  2. Department of Infectious Diseases, University Leiden Medical Center, Leiden, The Netherlands

    Jaap T. van Dissel

Authors
  1. Ivan M. Gan
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  2. Luana C. Ugahary
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  3. Jaap T. van Dissel
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  4. Jan C. van Meurs
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Corresponding author

Correspondence to Jan C. van Meurs.

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Gan, I.M., Ugahary, L.C., van Dissel, J.T. et al. Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis. Graefe's Arch Clin Exp Ophthalmo 243, 1186–1189 (2005). https://doi.org/10.1007/s00417-005-1182-1

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  • DOI: https://doi.org/10.1007/s00417-005-1182-1

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