What is the best local and parenteral antibiotic therapy for enterococcus fecalis endophtalmitis?

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Nissy Varughese

I would recommend vanco (hopefully sensitive) and Sanford Antimicrobial Therapy guide also recommends vanco 1 milligram + ceftazidime 2.25 milligram intravitreal. I posted an article for you so you can refer to the original article in the american journal of opth. Hope that helps.

http://www.ncbi.nlm.nih.gov/pubmed/25089354

Giuseppe Vittorio De Socio

Thank You Nissy. The ophthalmologist performed vitrectomy and iniection of vanco 1 milligram + ceftazidime 2.25 (according Sanford guide), but the the patient worsened. Enterococcus fecalis (found in vitreous sample) was sensitive to penicillin, vanco, teico, dapto, linezolid.

I have recommended (as infectious diseases consultant) systemic therapy with linezolid 600 mg x 2 and ampicillin 12 gr ev die, plus local vanco.What do you think?

Sounds appropriate considering the fluctuating MICs of the aforementioned drugs... Yes, vanco and systemic ampicillin and linezolid very good choices but would the inflammation limit appropriate vitreous concentration? I wish there was more info available on dapto but toxicity (cataracts) may limit its use... Any chance time may improve vision after abx tx... maybe couple of months? thank you so very much for sharing!