Endophthalmitis: Development of an Effective and Cost Saving Bacterial Killing Therapy
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Background: Endophthalmitis associated with intraocular procedures is an infection of the eye that can rapidly result in substantial irreversible loss of vision and may even lead to removal of the eye. Prevention strategies vary globally and often include antibiotic use – often consisting of a broad spectrum mono-therapeutic agent. The purpose of this study is to test the efficacy and value of combinations of cefuroxime (cefu), cefazolin (cefa), azithromycin (azith), and/or tobramycin (tob) as alternatives to the use of moxifloxacin. We looked for synergism since these antimicrobials used different mechanisms of inhibition.Methods: Initially, we examined individual antimicrobials to determine the minimal bactericidal concentrations (MBC) of each individual treatment, against Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, two clinical isolates of MRSA, and Staphylococcus epidermidis, by both the Zone of Inhibition (ZOI) and the Colony Forming Unit (CFU) assays. We then used this data in a combinatorial study. Results: We found combinations that were synergistic against all the bacteria tested, resulting in total killing of all bacteria. We found that the ZOI assay provided less consistent results than the CFU assays.Conclusions: We have found combinations of these antimicrobials that were synergistic in total killing (8 logs) of all bacteria tested. These three combinations were: cefu/azith; azith/tob; and cefu/tob. Moxifloxacin (Vigamox) did not completely kill Staphylococcus epidermidis