A Prospective Randomized Study to Determine the Efficacy of Preoperative Topical Levofloxacin in Reducing Conjunctival Bacterial Flora

• Published in: American journal of ophthalmology 2008, Vol.145 (1), p.136-142.e2
• Main Authors: Miño de Kaspar, Herminia, Kreutzer, Thomas C, Aguirre-Romo, Israel, Ta, Christopher N, Dudichum, Julia, Bayrhof, Markus, Klauss, Volker, Kampik, Anselm
• Format: Article
• Language: English
• Subjects: Administration, Topical; Aged; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis; Antibiotics; Bacteria; Bacteria - isolation & purification; Bacteriological Techniques; Biological and medical sciences; Cataract Extraction; Colony Count, Microbial; Conjunctiva - drug effects; Conjunctiva - microbiology; Cotton; Drug Therapy, Combination; Endophthalmitis - prevention & control; Female; Glaucoma - surgery; Humans; Keratoplasty, Penetrating; Levofloxacin; Male; Medical sciences; Miscellaneous; Ofloxacin - administration & dosage; Ophthalmic Solutions - administration & dosage; Ophthalmology; Patients; Postoperative Complications - prevention & control; Povidone-Iodine - administration & dosage; Prospective Studies; Standard deviation; Statistical analysis; Surgery; Treatment Outcome; Vitrectomy
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2007.08.031

Purpose To compare the efficacy of topical levofloxacin in combination with povidone–iodine irrigation vs povidone–iodine (PVI) alone in reducing conjunctival bacteria. Design Prospective, randomized, controlled trial. Methods One hundred and forty eyes of 140 patients scheduled to undergo intraocular surgery eyes were randomized to either group 1 or 2 (70 each). Whereas group 1 eyes had no prophylactic antibiotic, eyes in group 2 received topical treatment with one drop of 0.5% levofloxacin four times on the day before surgery. Both groups underwent irrigation of the fornices with 1% PVI. Conjunctival swabs were inoculated on solid and broth culture media to determine bacterial growth. Results Of 132 eyes evaluated, baseline culture analysis in thioglycolate demonstrated positive culture results in 55 (84.6%) of 65 eyes from group 1, similar to 55 (82.1%) of 67 eyes in group 2 ( P = .697). Before surgery, 57 (87.7%) of 65 eyes in group 1 had positive culture results, compared with 50 (74.6%) of 67 eyes in group 2 ( P = .055). After irrigation with PVI, 20 (30.8 %) of 65 eyes in group 1 had positive culture results, compared with only eight (11.9%) of 67 eyes in group 2 ( P = .008). After surgery, 15 (23.1%) of 65 eyes in group 1 and six (9.0%) of 67 eyes in group 2 had positive culture results ( P = .027). Conclusions Our study shows an enhanced effect of using topical levofloxacin in combination with PVI irrigation to reduce conjunctival bacteria in patients undergoing intraocular surgery.