Oral Gatifloxacin: A Novel Treatment Paradigm for the Management of Filtering Bleb Infection

Abstract

Abstract: : Purpose: We previously reported that gatifloxacin, a fourth-generation fluoroquinolone antibiotic, can achieve therapeutic concentrations in the aqueous and vitreous humor after oral administration in the non-inflamed human eye. It adequately exceeds the MIC₉₀ of the most frequently encountered organisms found in various causes of bacterial endophthalmitis. We propose a novel approach to the management of localized filtering bleb infection based on our experience of five patients successfully treated with oral gatifloxacin in conjunction with topically administered antibiotic. Methods: Five consecutive patients with localized bleb purulence were treated with oral gatifloxacin 400mg tablets (BID loading dose for one day followed by QD thereafter) in conjunction with topically administered antibiotic (ofloxacin QID, ciprofloxacin QID, or fortified ceftazadime/tobramicin QID). Excluded were those patients with frank endophthalmitis. Results: An antifibrotic agent (mitomycin-C) was used and the filtering bleb was located superiorly in all cases. A history of Seidel positivity was documented in four of the five patients. Cultures of the superior conjunctiva were obtained in two patients revealing Streptococcus pneumoniae in one and Staphylococcus aureus in the other. All five patients had prompt resolution of bleb purulence and tolerated the treatment regimen very well. Conclusions: Based on our small case series it appears that the use of orally administered gatifloxacin may represent a new treatment paradigm for the management of localized filtering bleb infections. Gatifloxacin has MIC₉₀ levels significantly lower than other fluoroquinolone agents and has a spectrum of coverage encompassing those organisms which are most frequently cultured in bleb-associated endophthalmitis. Furthermore, it penetrates well into the non-inflamed human eye and is well tolerated after oral administration. A prospective, randomized clinical trial is indicated to truly elucidate whether improved outcomes are achieved by the use of oral fourth generation fluoroquinolones in this clinical setting.

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