Prospective Comparison of 1-Day vs 1-Hour Pre-Operative Topical Gatifloxacin Prophylaxis for Intraocular Surgeries

Abstract

Purpose:: To determine the efficacy of topical gatifloxacin in eliminating conjunctival bacterial flora following a one-hour versus one-day application in patients undergoing intraocular surgery.

Methods:: Prospective, masked non-randomized evaluation of 96 eyes in 48 patients scheduled to undergo intraocular surgery (cataract, trabeculectomy, or corneal transplant). Cultures were taken from the palpebral conjunctival sacs in both eyes at baseline (T0). All patients were instructed to apply topical gatifloxacin into surgical eye 4 times a day beginning 1 day prior to surgery. On the day of surgery, cultures were taken from both eyes (T1) where the surgical eye received antibiotics for 1 day prior and the contralateral eye has received no treatment. One hour prior to surgery, both eyes received 3 additional doses of antibiotic given 5 minutes apart. Cultures were obtained 45 minutes following these last doses of antibiotic (T2), where the surgical eye received both 1-day and 1-hour preoperative antibiotics, and the non-surgical eye received only 1-hour preoperative antibiotic treatment. Culture swabs were inoculated onto sheep blood agar plates and SeptiChek culture broth and incubated at 37°C for 5 days. The individuals obtaining the cultures and analyzing the results were masked with regard to surgical/non-surgical eye groups.

Results:: For blood agar, the percentage of positive culture decreased from 56% at baseline to 13% following one day and one hour of topical antibiotic (p=6.4 x 10^-6). Similarly, the non-surgical eye showed a decrease from 63% at baseline to 13% after just one hour application of antibiotic (p=4.2 x 10^-7). For SeptiChek, the decrease in positive culture is from 69% at baseline to 25% after a one day and one hour application of antibiotic (p=1.75 x 10^-5). Following only one hour application of antibiotic, there was also a decrease in percentage of positive cultures from 75% to 40% (p=.0005) in the non-surgical eye. There was no statistical significance at T2 comparing the one day versus a one hour antibiotic application (p=1.0 for blood agar, p=.127 for SeptiChek).

Conclusions:: A 1-hour application of topical gatifloxacin appears to be as effective as a 1-day application in eliminating conjunctival bacteria flora in patients undergoing intraocular surgery.

Clinical Trial:: www.clinicaltrials.gov NCT00350363

Keywords: endophthalmitis • bacterial disease • antibiotics/antifungals/antiparasitics