domesticsale.info - Antibiotic Therapy for Postoperative Endophthalmitis - EVpedia

BUY NOW For Sale 70%!
buy viagra

Ciprofloxacin iv rate drops

I. Dosages and preparation of antibiotics

attn : intraocular injection and intraocular infusion are alternative options, do not use both simultaneously !

Vancomycin (Vancomycin Lilly 500®)
Vancomycin 500mg vial final concentration application (quantity)
1 intraocular injection 1mg/0,1cc 0,1cc
2 intraocular infusion 0,2mg/cc no limit
3 subconjunctival injection 25mg 0,25cc
4 eye drops 50mg/cc up to every hour

1. intraocular injection
a. dissolve 500mg Vancomycin in 10cc 0,9% NaCl (=50mg/cc)
b. dilute 2cc of the solution (=100mg) with 8cc 0,9% NaCl (=10mg/cc)
c. draw in tuberculin syringe (more precise dosage measurement when compared to standard 2cc syringes)
d. inject 0,1cc (=1mg) into midvitreous.

2. intraocular infusion
a. dissolve 500mg Vancomycin in 10cc 0,9% NaCl (=50mg/cc)
b. put 2cc of the solution (=100mg) into 500 cc BSS (=0.2mg/cc)
c. (if 5cc BSS solution remains within the vitrectomized eye, that is the same quantity of Vancomycin compared to an intravitreal injektion (s. #1d)

3. subconjunctival injection
a. dissolve 500mg Vancomycin in 5cc 0,9% NaCl (100mg/cc)
b. inject 0,25cc (=25mg)
c. or : take solution #1a and inject 0,5cc

4. eye drops
a. use solution #1a as eye drops
b. or : dissolve 500mg Vancomycin in 10ml artificial eye drops
c. store in fridge, shake solution before applying to the eye !

Amikacin (Biklin®)
Amikacin 100mg vial final concentration application (quantity)
1 intraocular injection 0,4mg/0,1cc 0,1cc
2 intraocular infusion 0,08mg/cc no limit
3 subconjunctival injection 25mg 0,55cc
4 eye drops don’t use up to every hour

1. intraocular injection
a. begin with 100mg vial (2cc) Amicacin
b. take 0,8cc (=40mg) and dilute with 9,2cc 0,9% NaCl to have 10cc (=4mg/cc)
c. draw in tuberculin syringe for intravitreal injection
d. inject 0,1cc (=0,4mg) into the midvitreous.

2. intraocular infusion
a. draw 0,8cc (40mg) from a 100mg vial and put into 500cc BSS-infusion bottle (=0,08mg/cc)
b. (if 5cc BSS solution remain within the vitrectomized eye, that is the same quantity of amikacin when compared to an intravitreal injection (s. #1d)

3. subconjunctival injection
a. draw undiluted Amicacin from the 100mg vial
b. inject 0,5cc (=25mg)

4. eye drops
a. Amikacin solution from the vial does not penetrate the cornea.
b. take standard aminoglykosid eye drops containing Gentamicin or Tobramicin.

Gentamicin (Refobacin®) und Tobramycin (Gernebcin®)

Alternatively to Amikacin, 2nd choide aminoglykosid with broad gram-neg. spectrum.

Gentamicin/Tobramicin 40mg vial final concentration application (quantity)
1 intraocular injection 0,1mg/0,1cc 0,1cc
2 intraocular infusion 0,08mg/cc no limit
3 subconjunctival injection 25mg 0,5cc
4 eye drops don’t use up to every hour

1. intraocular injection
a. begin with 40mg vial that contains1cc (=40mg/cc)
b. take 0,1cc (=4mg) and dilute with 3.9cc 0,9% NaCl to have 4cc (=1mg/cc)
c. draw in tuberculin syringe for intravitreal injection
d. inject 0,1cc (=0,1mg) into the midvitreous.

2. intraocular infusion
a. put one 40mg vial into 500cc BSS-infusion bottle (=0,08mg/cc)
b. remark : this is also the standard dosage, if you use antibiotic containing infusion routinely for intraocular surgery.
attn : the total amount of the drug within the eye can be higher in comparison to intravitreal injection alone. The non-toxic therapeutic range of Gentamicin is 0.1-0,4mg.

3. subconjunctival injection
a. draw undiluted Gentamicin from the vial, inject 0,5cc (=20mg).

4. eye drops
a. take standard aminoglykosid eye drops containing Gentamicin or Tobramicin.

Ceftazidime (Fortum®)

3rd generation cephalosporine with a broad spectrum against gram-pos and gram-neg. bacteria : Use instead of amikacin, if there are contraindications for aminoglykosids.

Ceftazidime 500mg vial final concentration application (quantity)
1 intraocular injection 2,25mg/0,1cc 0,1cc
2 intraocular infusion 0,45mg/cc no limit
3 subconjunctival injection 100mg 0,5cc
4 eye drops 50mg/cc up to every hour

1. intraocular injection
a. take 500mg vial (powder) and dissolve in 10cc 0.9%NaCl (=50mg/cc)
b. take 1cc (=50mg) and dilute with 1,2cc 0,9% NaCl (=22,7mg/cc)
c. draw in tuberculin syringe for intravitreal injection
d. inject 0,1cc (=2,27mg) into the midvitreous.

2. intraocular infusion
a. take 500mg vial (powder) and dissolve in 10cc 0.9%NaCl (=50mg/cc)
b. take 4,5cc (225mg) and put into 500cc BSS-infusion bottle (0,45mg/cc)
c. (if 5cc BSS solution remain within the vitrectomized eye, that is practically the same quantity of Ceftazidime when compared to an intravitreal injection (s. #1d).

3. subconjunctival injection
a. solution #1a or #2a can be used, however 2cc are needed (too much volume)
b. therefore, take a 500mg vial and add only 2,5cc 0,9% NaCl to dissolve the powder and inject 0,5cc (=100mg).

4. eye drops
a. take 500mg powder vial and dissolve with 9,6cc artificial tear drops or 0,9% NaCl.

Amphotericin B (Amphotericin B®, Quibb-Heyden)

Indications : recurrent endophthalmitis of suspected fungal origin. Typical clinical features are : infiltrates forming strands and balls in anterior chamber and vitreous cavity, white infiltrates at the limbus and in the cornea adjacent to the corneal and scleral wound.

Different from postoperative endophthalmitis of bacterial origin, systemic treatment for 4-8 weeks is generally recommended :
1. Amphothericin B intravenously (though poor penetration of the blood/retina barrier) or 2. Fluconazole=Diflucan® intravenously (proven good penetration into the cerebrospinal fluid, thus also penetrating the blood/retina barrier). After 2 weeks, therapy can be switched to oral medication : e.g.. Fluconazole (s.o.) oder Ketoconazole (Nizoral®).
attn : most anti-fungal drugs are effective against Candida species, but other fungal strains may primarily not respond to the drug. Furthermore, several species can develop resistance during antifungal therapy. If necessary, medication must be changed. Systemic antifungal therapy can have serious side effects, particularly when Amphothericin B is used. Initial therapy should be performed in a hospital setting and in close cooperation with an internist.

Amphotericin B 50mg vial final concentration application (quantity)
1 intraocular injection 0,005mg/0,1cc 0,1cc
2 intraocular infusion 0,02mg/cc no limit
3 subconjunctival injection 5-10mg 0,5cc
4 eye drops 0,1% up to every hour

1. intraocular injection
a. 50mg vial in 10cc Aqua (=5mg/cc)
b. take 0,1cc (=0,5mg) and dilute with 9,9cc Aqua (=0,05mg/cc)
c. draw in tuberculin syringe for intravitreal injection
d. inject 0,1cc (=0,005mg) into the vitreous cavity.

2. intraocular infusion :
a. 50mg vial in 10cc Aqua (=5mg/cc)
b. take 2cc (=10mg) and put into 500cc BSS-infusion bottle (=0,02mg/cc)
c. (if 5cc BSS solution remain within the vitrectomized eye, that is the same quantity of Amphothericin B when compared to an intravitreal injection (s. #1d).

3. subconjunctival injection :
a. dosage for a single application : 5-10mg
b. take 50mg vial and dilute with 5cc Aqua (=10mg/cc)
c. inject 0,5-1cc (very painful !, mix with local anaesthesia)
d. especially indicated, if fungal infiltrates are present in the anterior segment (corneal or scleral wound site, filtering bleb).

4. eye drops
a. 0,1% Amphotericin B solution : Take solution #1a and dilute with 50cc Aqua (=1mg/cc)
b. do not use higher concentrations (toxic effects) : corneal ulcer, anterior uveitis.

Voriconazole (Vfend®, Pfizer)

Indications : recurrent endophthalmitis of suspected fungal origin. Others : fungal infection after filtrating surgery, buckle surgery, endogenous fungal endophthalmitis. Broad-spectrum antifungal therapy, particularly effective in aspergillus species, generally well tolerated (no nephrotoxicity), complete enteral resorption, good penetration into the eye (better BRB-penetration compared to amphothericin B).
Different from postoperative endophthalmitis of bacterial origin, systemic treatment for 4-8 weeks is generally recommended according to the clinical picture.

Voriconazole 200mg vial final concentration application (quantity)
1 intraocular injection 0,05mg/0,1cc 0,1cc
2 intraocular infusion No recommendation
3 subconjunctival injection No recommendation
4 eye drops No recommendation

1. intraocular injection
a. 200mg vial in 19cc Aqua (=10mg/cc)
b. take 1cc (=10mg) and dilute with 19cc Aqua (=0,5mg/cc)
c. draw in tuberculin syringe for intravitreal injection
d. inject 0,1cc (=0,05mg) into the vitreous cavity.

2. systemic treatment :
Day 1 : 800mg (2x400mg iv or orally, 12h apart, <40kg : 6mg/kg infusion) ≥2 day : continue with 400mg (2x200mg iv or orally, 12h apart, <40kg : 4mg/kg infusion)

Dexamethason-phosphat (Fortecortin® Inject)

Current controversy about steroids as an adjunct : yes or no ? Rationale pro : host inflammatory response with damage to the ocular tissue is reduced and better functional results are achieved. A possibly negative effect on visual outcome after the use of antibiotics & steroids was published by Shah et al. ; Ophthalmology 107 : 486ff, 2000. Another study showed a potential beneficial effect (Gan, Graefes Arch, 2005).
Animal experiments have shown conflicting results (different infection models). So far, no randomized clinical study was performed. Until now, no general recommendations can be given. Many VR surgeons recommend the additional application of steroids to suppress the inflammatory host response. In our experience, intravitreal or systemic steroids are not crucial for treatment of postoperative endophthalmitis.

Dexamethason 4mg vial final concentration application (quantity)
1 intraocular injection 0,4mg/0,1cc 0,1cc
2 intraocular infusion 0,04-0,08mg/cc no limit
3 subconjunctival injection 2mg 0,5cc
4 eye drops 0,1% up to every hour

1. intraocular injection
a. 1 vial (1cc) contains 4mg.
b. take 0,1cc of the original drug for intravitreal injection (0,4mg)
c. attn : steroids can be mixed with the antibiotic solution (no need for repetitious injection)

2. intraocular infusion
a. 1 vial containing 40mg (=1cc) into the 500cc BSS-infusion bottle (0,08mg/cc)
b. (if 5cc BSS solution remains within the vitrectomized eye, that is the same quantity of Dexamethason when compared to an intravitreal injection (s. #1b).
c. some authors recommend 20mg ciprofloxacin iv rate drops in 500cc BSS (half dosage).

3. subconjunctival injection (look for Dexamethason-phosphat in appropriate dosage units)
a. 1-2mg Fortecortin® (=0,5-1cc)

4. eye drops 0,1% : many meds commercially available

II. Antibiotic and drug therapy & surgery for postop endophthalmitis (simplified scheme)

.

1.acute/early Eo
  • Surgery : vy + posterior capsuotomy (no IOL-removal)
  • Intravitreal : Vancomycin Amikacin
  • Postop. Sub-conjunctival : optional (same drugs)
  • Topical (drops) : commercial meds or same as above
  • Systemic Tx : NONE !
  • Infrastructure : In- & outpatient Tx
  • remarks : less severe clinical presentation : ev TAP only (EVS).
2.chronic/late Eo
  • Surgery : vy + subtotal capsule excision (no IOL removal)
  • Intravitreal:Vancomycin Amikacin
  • Postop. Sub-conjunctival : optional (same drugs)
  • Topical (drops) : commercial meds or same as above
  • Systemic Tx : 1. Ciprofloxacin orally or 2. Moxiflocain orally or 3. Ceftazidime iv
  • Infrastructure : In- & outpatient Tx.
3.recurrent Eo (bacterial)
  • Surgery : vy + IOL-removal + total excision of lens capsule
  • Intravitreal : Vancomycin Amikacin
  • Postop. Sub-conjunctival : optional (same drugs)
  • Topical (drops) : commercial meds or same as above
  • Systemic Tx : 1. Ciprofloxacin oral or 2. Ceftazidime iv or 3. Imipenem iv(+ consider lab results)
  • Infrastructure : In- & outpatient Tx.
4.fungal Eo
  • Surgery : vy + IOL-removal + total excision of lens capsule
  • Intravitreal : Amphotericin B Ketoconalzole Voriconazole
  • Postop. Sub-conjunctival : eventually Amphothericin B
  • Topical (drops) : same drugs
  • Systemic Tx : Initially iv : Amphotericin B or Fluconazole, or Voriconazole, afterwards oral meds
  • Infrastructure : inpatient Tx.
PS : Systemically administered antibiotics :

Basically, you can use the same drugs for local and systemic therapy. If you decide for systemic treatment, consider the following :

  • possible systemic side effects (elderly patients !)
  • the ability of the drug to penetrate blood/aqueous barrier and blood/retina barrier. There is not much known about intraocular penetration. In general, if a drug is known to penetrate into the cerebrospinal fluid (blood/brain barrier), it also penetrates into the eye.

The general assumption that the blood/aqueous barrier and blood/retina barrier is more permeable in inflamed eyes, is based on theoretical considerations. Many antibiotic drugs used penetrate into the eye very poorly, particularly aminoglyosides (vancomycin also !).

Experimental data has shown, that carbapenems are highly effective in endophthalmitis, too. They are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity and have a structure that renders them highly resistant to beta-lactamases. Advantageous is the broadest antibacterial spectrum (compared to other beta-lactam classes such as penicillins and cephalosporins). They are generally resistant to the typical bacterial beta-lactamase enzymes which is one of the principal resistance mechanisms of bacteria. Carbapenems are effective against both, gram-positive and gram-negative bacteria, with the exception of intracellular organisms (propionibacterium). Imipenem/cilastatin (Zienam®) is available for intravenous use only. Usual dosage is 500mg every 6-8 hours.

Fluoroquinolones (gyrase inhibitors) have shown a good penetration through the blood/brain barrier and also through the blood/retina barrier, even with oral administration (ciprofloxacin, oflaxacin, levofloxacin). In addition, they cover a broad antimicrobial spectrum. In particular, they are effective against most of the microorganism that are involved in postoperative endophthalmitis (gram+ and gram- incl. Propionibacterium). Even with oral admission, high aqueous and vitreous MIC are achieved that are sufficient to kill all bacteriae.
Noteworthy, it takes 1 - 2 days until maximum intraocular levels are achieved. Preliminary results with moxifloxacin and gatiflocacin (fluoroquinolone of the 4th generation : Bonoq®, Avalox®) are promising for the use in endophthalmitis. In Germany, Bonoq® was taken off the market because of the risk of hypo¬glycemia. In general, fluoroquinolones are well tolerated and have much fewer side effects compared to aminoglycosides. However, an increasing rate of resistant bacteria was reported recently. For topical administration, fluoroquinolones are commercially available (Vigamox® - Alcon, Zymar®, - Allergan). Moxifloxacin is available for oral and iv admission : oral 2x 400mg on day 1, thereafter 400mg/day (half-life 13h !!) – intravenously 400mg/250cc infusion per day.

PS : Although there is general consensus (see recommendations by scientific societies) to use antibiotics intravitreally or systemically in endophthalmitis, none of the drugs is approved for this indication. In other words, their use is off-label from the legal point of view. Nonetheless, nobody would question to apply antibiotic treatment in such cases. It has become good clinical practice. Not performing adequate endophthalmitis treatment could result in prosecution for medical malpractice.


Source: http://www.evpedia.org/spip.php?article25


BUY NOW For Sale 70%!
buy viagra

Welcome to Kuwait Pharmacy Ciprofloxacin 500 mg ear infection

Ciprofloxacin iv rate drops Cached
Ciprofloxacin iv rate drops 4 Prescriptions - m
Ciprofloxacin iv rate drops Answers - A place to go for all the Questions and Answers
Ciprofloxacin iv rate drops Antibiotikatherapie in der Hals-Nasen-Ohren-Heilkunde
Ciprofloxacin iv rate drops Augmentin (Amoxicillin Clavulanate Side Effects)
Ciprofloxacin iv rate drops Aux quatre saisons - m
Ciprofloxacin iv rate drops CILODEX 3 mg/ml / 1 mg/ml ear drops, suspension
Caffeine manufacturers, India Taj Pharmaceuticals Cipro IV (ciprofloxacin) dose, indications, adverse Ciprofloxacin (Cipro) for UTI: Dosage, How Long It Takes to Works Ciprofloxacin: Side Effects, Dosage, Uses - Healthline Companies and intellectual property registration office DailyMed - LEVOFLOXACIN - levofloxacin injection Houdt u van grapefruit? LOCATION Haubentaucher Revalerstr NEBENWIRKUNGEN
BUY NOW For Sale 70%!
buy viagra