Fluoroquinolones: do not taper dose

Tapering the dose of a topical fluoroquinolone at the end of a course of treatment is a great way to build up bacterial resistance. As such, doctors must not taper the dosage at the end of treatment, according to Dr Richard L. Abbott.

"Fluoroquinolones are not like corticosteroids, where you might go from qid, tid, bid. With a fluoroquinolone, that's a great a way to build up resistance. The regimen should be qid for one week or two weeks postop and then stop," Dr Abbott told delegates at lunchtime symposium on antibiotic prophylaxis in cataract surgery sponsored by Santen.

The ESCRS, in its recently published guidelines on prevention, investigation and management of postoperative endophthalmitis, recommends that cataract surgeons consider using a topical fluoroquinolone. The regimen is four times a day for 48 or 24 hours prior to surgery, immediately postop, and up to two weeks afterwards. This is in addition to an intracameral cefuroxime injection that has become the proven prophylaxis regimen following the publication of the ESCRS Endophthalmitis study last year.

The ESCRS recommends a one-week postop regimen if a scleral tunnel or sutured clear cornea incision is used, and two weeks if with an unsutured clear corneal incision. The ESCRS guidelines cite levofloxacin or ofloxacin as the fluoroquinolone of choice, but note also that three studies indicate that levofloxacin gives three to four times higher levels of the active isomer in the anterior chamber.

Dr Abbott was hopeful that fluoroquinolones would remain a viable treatment for some time to come if doctors do not taper the dose.