Empiric treatment of endophthalmitis. Are aminoglycosides necessary?

Arch Ophthalmol. 1994 Jan;112(1):45-7. doi: 10.1001/archopht.1994.01090130055016.


Objective: To reevaluate the necessity of empiric gram-negative therapy for postoperative endophthalmitis based on the recognition of aminoglycoside-induced toxic effects.

Methods: A review of 162 cases of culture-positive bacterial endophthalmitis to determine bacterial prevalence, antibiotic susceptibilities, and laboratory staining results of intraocular material.

Results: One hundred fifty (93%) gram-positive and 12 (7%) gram-negative isolates. All the gram-positive bacteria were susceptible to vancomycin hydrochloride; and gram-negative bacteria were susceptible to gentamicin sulfate, amikacin sulfate, and ceftazidime sodium. Bacterial rods were observed on smear of intraocular material in 10 gram-negative cases submitted for examination.

Conclusion: Vancomycin is an appropriate single agent if laboratory studies rule out gram-negative infection. In the absence of laboratory support, an aminoglycoside (possible toxic effects) or another gram-negative antibiotic (possibly ceftazidime) should also be administered.

Publication types

  • Comparative Study

MeSH terms

  • Aminoglycosides
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / drug effects
  • Bacteria / isolation & purification
  • Ceftazidime
  • Cephalosporins / administration & dosage*
  • Cephalosporins / pharmacology
  • Cephalosporins / therapeutic use
  • Endophthalmitis / drug therapy*
  • Endophthalmitis / microbiology
  • Eye Infections, Bacterial / drug therapy*
  • Humans
  • Microbial Sensitivity Tests
  • Postoperative Complications
  • Vancomycin / administration & dosage*
  • Vancomycin / pharmacology
  • Vancomycin / therapeutic use


  • Aminoglycosides
  • Anti-Bacterial Agents
  • Cephalosporins
  • Vancomycin
  • Ceftazidime