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K. Johnson, D. Miller, T. Johnson; Eyelid Abcesses: Which Emperic Antibiotic?. Invest. Ophthalmol. Vis. Sci. 2007;48(13):770.
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Patients presenting with bacterial eyelid infections are treated empirically while waiting for culture and sensitivity results. The incidence of community-acquired methacillin-resistant Staphylococcus aureus has more than doubled since the 1980’s, raising the question of which medication should be used for this empiric treatment at first presentation.
Microbiology specimens for eyelid cultures were reviewed from January 2000 through November 15, 2006 at the Bascom Palmer Eye Institute. The percent sensitivity of all organisms was evaluated for Ampicillin/Sulbactam, Cefazolin, Ciprofloxacin, Gentamicin, Trimethoprim/Sulfamethoxazole, and Vancomycin.
All gram positive isolates accounted for 74.5%, whereas gram negative organisms accounted for 25.5%. Staphylococcus aureus was the most common isolate (56.8%), with methacillin-resistance found in 35% of these cases. Against all isolates, the percent of organisms sensitive to the antibiotics were: Ampicillin/Sulbactam 57.9%, Cefazolin 58.5%, Ciprofloxacin 85.4%, Gentamicin 95.8%, Trimethoprim/Sulfamethoxazole 98.3%. Vancomycin was 99% sensitive for S. aureus and not measured for the gram negative organisms.
With the rise in community-acquired MRSA, the efficacy of beta-lactam-based antibiotics is decreasing. Trimethoprim/Sulfamethoxazole shows high bacterial sensitivity with easy twice-daily dosing and should be considered in first-line empiric treatment of eyelid infections.
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