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Purpose: To study intravitreal dexamethasone and vancomycin concentrations,when used together in patients with suspected postoperative bacterial endophthal mitis. 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 μ g 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 outof 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.
Purpose: To study intravitreal dexamethasone and vancomycin concentrations, when used together in patients with suspected postoperativeoperative bacterial endophthal mitis. 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 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 The results showed that average concentration of 25 ng / ml for 3 days after injection, with an estimated half-life of 5.5 h. Vancomycin concentrations in patients given dexamethasone tended to be higher than 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.