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Is preoperative antibiotic use in cataract surgery scientifically justified?

Session Details

Session Title: Inflammation

Session Date/Time: Tuesday 08/10/2013 | 16:30-18:00

Paper Time: 16:30

Venue: Auditorium (First Floor)

First Author: : A.Grzybowski POLAND

Co Author(s): :    P. Pucilowska              

Abstract Details

Purpose:

To assess the effectiveness of preoperative topical antibiotics comparing to povidone-iodine use in ocular surgery.

Setting:

Endophthalmitis is one of the most serious complications of the ocular surgery leading in most cases to a significant decrease in vision. The use of preoperative antibiotics and / or povidone-iodine has been advocated as an effective measure to prevent endophthalmitis, although it was never proved in a prospective trial. The additional benefit of topical preoperative antibiotics to povidone-iodine alone is controversial, and should be balanced with the risk of producing antibacterial resistance, an increasing problem of modern medicine.

Methods:

Analysis of reports published in years 2008-2012 on preoperative use of topical antibiotics compared to povidone-iodine in ocular surgery. rticles were divided into three groups: topical antibiotic use, iodine – povidone use and reports on bacteria antibiotic resistance. The study included analysis of 7 articles on antibiotics and 10 articles on antibiotics and povidone – jodine.

Results:

It was shown that in decreasing conjunctival bacterial numbers: 1. 3 days preoperative use of major antibiotics is as effective as 1 hr preoperative use; 2. povidone-iodine is as effective as antibiotic; 3. Single 5% povidone-iodine use is less effective than twice irrigation with the same solution; 4. 10% povidone –iodine is more effective than 1% poviodone-iodine. Moreover, preoperative antibiotic use did not lower the endophthalmitis rate.

Conclusions:

Adding the antibiotic to povidone-iodine brings no clear benefit. The antimicrobial resistance is known to be produced by repeated, overused and extended use of antibiotics, and might lead to development of treatment-resistant infections, including severe forms of endophthalmitis. Moreover, in majority of European countries this preoperative use of antibiotics is not included in Summary of Product Characteristics, it can thus be treated as an off-label use.

Financial Interest:

NONE