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R.G. Fiscella, A. Chen, E. Tu, M. Sharma, J. Pulido, W.W. Lai, B. Buerk, N. Blair, M. Shapiro; Intraocular Penetration in Humans of Oral Plus Topical Gatifloxacin . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4893.
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Purpose: Gatifloxacin is a fourth generation fluoroquinolone that provides broad–spectrum coverage, good intraocular penetration, low minimum inhibitory concentrations (MIC’s) and is well tolerated. Previous studies showed successful penetration into aqueous and vitreous fluids after oral administration. We wished to determine the penetration into the aqueous, vitreous and the serum concentrations after oral plus topical gatifloxacin. Methods:Patients undergoing primary vitrectomy and received oral and topical gatifloxacin administration. Two 400 mg tablets of gatifloxacin were given prior to surgery, the first tablet 24 hours prior to surgery and the second tablet on the morning of surgery. The patients also received 0.3% topical gatifloxacin on day of surgery 1 drop times four at 15 minute intervals with last drop given approximately 30 minutes prior to surgery. If interval between last drop administered and aqueous and vitreous collection was longer than 30 minutes, an additional drop was given at 15 minute intervals so the last drop still given 30 minutes prior to surgery. Patients had 0.1 ml aqueous and 0.2 ml mid–vitreous collected prior to any intraocular infusion. Blood was collected and the serum frozen. All aqueous, vitreous and serum samples were immediately placed on ice and stored at –70 degrees Celsius. All samples sent to University of Arizona for HPLC analysis and validated by reverse–phase HPLC procedure Results: There were 8 patients (5 women, 3 men) averaging 65 years of age. The aqueous concentration (µg/ml) averaged 1.32 + 0.78. (median 1.3; range 0.364–2.908). The vitreous concentrations average 1.09 + 0.31(median 1.13; range 0.678–1.581). The serum concentrations averaged 4.00 + 1.54 (median 3.35; range 2.55–7.1). Conclusions: Combination of topical and oral gatifloxacin led to good aqueous humor and vitreous humor levels. The combined regimen achieved MIC 90s’ against most pathogens including S. aureus, S. epi, S. pneumoniae, S. pyogenes, S. viridans, P. acnes, H. influenzae, Enterococcus species, B.cereus, P. mirabilis, M.fortuitum.
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