Does Cefuroxime Provide Better in vitro Susceptibility Than the 4Th Generation Fluoroquinolones and Cefazolin?

Abstract

Purpose:: To compare the in vitro susceptibility of cefuroxime, a 2^nd generation cephalosporin that is being used in Europe for prophylaxis as an intracameral injection, to moxifloxacin, gatifloxacin, and cefazolin (1^st generation cephalosporin).

Methods:: The MICs were determined for 92 bacterial isolates from endophthalmitis (Mather Study) to cefuroxime and cefazolin using E-tests. The in vitro susceptibility profiles were compared statistically (Monte-Carlo Randomization) to the previously determined moxifloxacin and gatifloxacin susceptibility results (determined from E-tests)(Mather Study).

Results:: The in vitro susceptibility profiles for the four antibiotics were statistically equivalent for Staphylococcus aureus (N=14), Coagulase-Negative Staphylococcus (N=20), Streptococcus pneumoniae (N=10), St viridans (N=10), Beta-hemolytic streptococcus (N=5), and Haemophilus (N=4). Moxifloxacin and gatifloxacin provided higher susceptibility to Bacillus (N=9), Enterococcus (N=9), and Gram-Negative Bacteria (N=11) than cefuroxime and cefazolin. Against all isolates, the in vitro susceptibility profiles of cefuroxime and cefazolin were equivalent.

Conclusions:: This study suggests, that based on in vitro susceptibility testing using actual endophthalmitis isolates, moxifloxacin and gatifloxacin would provide wider antibacterial coverage than cefuroxime or cefazolin. While the debate over the efficacy of intracameral antibiotics for the prophylaxis of post operative endophthalmitis continues, fourth generation fluoroquinolones may provide more broad spectrum coverage of endophthalmitis causing bacteria than cefuroxime.Independent Study: No pharmaceutical support.

Keywords: clinical laboratory testing • endophthalmitis • anterior chamber