Effects of topical azithromycin, moxifloxacin, and povidone iodine on conjunctival bacterial flora in patients undergoing intravitreal injection.

Kuddusi Teberik,Handan Ankaralı,Mehmet Tahir Eski,Emel Çalışkan,Murat Kaya,Özge Kılınçel

doi:10.5935/0004-2749.20190008

Abstract

To compare effects of 5% topical povidone iodine with prophylactic topical azithromycin and moxifloxacin on bacterial flora in patients undergoing intravitreal injection. A total of 132 patients were randomly assigned to receive treatment with azithromycin or moxifloxacin, or no treatment (control group). In total, 528 specimens were obtained at the time of admission, 4 days before intravitreal injection, 4 days after intravitreal injection, and 8 days after intravitreal injection. Samples were immediately sent to the microbiology laboratory for incubation. The microorganism observed most frequently was coagulasenegative Staphylococcus (23.8%). When the results of samples obtained on Day 4 before injection were assessed, growth of coagulase-negative Staphylococcus was significantly lower in the moxifloxacin group, compared with controls (p=0.049). Acinetobacter baumannii continued to grow after administration of azithromycin (p=0.033). When the results of four days after intravitreal injection were evaluated, growth of coagulase-ne gative Staphylococcus was higher in controls, compared with patients who received azithromycin or moxifloxacin (p=0.004). Eradication rate was significantly higher in the moxifloxacin group than in the control group (p=0.001). Samples obtained on Day 8 after intravitreal injection showed similar levels of bacterial growth in all groups (p=0.217). Moxifloxacin was more effective than 5% povidone iodine in controlling the growth of conjunctival bacterial flora. Use of moxifloxacin in combination with 5% povidone iodine resulted in a synergistic effect.

Highlights

Toxic retinopathy (TR) caused by antimalarials, first described in 1951, is a rare adverse effect that causes irreversible vision loss[1,2,3,4]
The prevalence of TR caused by antimalarials was 4.15%, occurring in 9 of 217 patients
The prevalence of toxic maculopathy was 7.4% from chloroquine diphosphate (CQ) usage (4 of 54 patients; 95% CI: 0.0042 to 0.143) and 0.82% from HCQ usage (1 in 121 patients; 95% CI: 0.00786 to 0.02438)

Summary

Introduction

Toxic retinopathy (TR) caused by antimalarials, first described in 1951, is a rare adverse effect that causes irreversible vision loss[1,2,3,4]. The prevalence of TR differs among antimalarials. The risk factors for antimalarial TR described by the American Academy of Ophthalmology in 2016 were categorized as major and minor. The minor risk factors are age over 60 years, presence of liver disease, and generic factors (anomaly in ABCA423-2016 or P45024-2016 gene 4). The major risk factors are period of exposure greater than 5 years, nephropathy, concomitant use of tamoxifen, previous presence of ma culopathy, and dose/kg of antimalarials (for hydroxychloroquine - HCQ, greater than 5.0 mg/kg of actual weight and for CQ, greater than 2.3 mg/kg of actual weight)(4)

Methods

Results

Conclusion