Effectiveness of Preoperative Antibiotic Use
Narrative Responses:
Purpose
The aim of this paper is to review the effectiveness of the preoperative endophthalmitis prophylactic measures currently in use.
Methods
A literature search through Pub Med was performed for prospective or retrospective studies on the use of prophylactic preoperative antibiotics, iodine compounds and chlorhexidine solutions. The following key words were used: ocular surgery, antibiotics, cataract surgery, preoperative ocular surgery prophylaxis, and eliminating conjunctival sac bacteria. Additional advanced search criteria were the time period from January 1 2008 until December 31 2012, humans and English language. For the final analysis, 17 articles were chosen, which were divided into two groups: antibiotics (7 studies), and iodine compounds (10 studies).
Results
Higher concentrations of povidone-iodine (10%), longer exposure time of PVI and increased number of its applications have resulted in decreased amounts of positive bacteria flora growth from the conjunctival sac. The addition of antibiotics preoperatively has not resulted in any effective reduction of this bacterial flora.
There is no conclusive evidence for a strategy, which would result in complete eradication of postoperative endophthalmitis. The consensus is that pretreatment with 5% povidone-iodine for at least 15 minutes or repeated applications over 10 minutes is effective in the reduction of conjunctival organisms, and this should result in less PE.
Conclusion
There is no strong evidence to support the addition of antibiotics preoperatively.