Fluoroquinolones: do not taper dose

Article

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.

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.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
At the Retina World Congress, Siegfried Priglinger, MD, speaks about ensuring the best outcomes for preschool-aged patients
At the 2025 ASCRS meeting, Robert Ang, MD said small aperture IOLs can benefit all patients, especially those with complex corneas or who have undergone previous corneal refractive surgery
Viha Vig, MBChB graduate student at the University of Auckland, New Zealand, discusses her poster presentation on the relationship between mitochondiral disease, Alzheimer disease, and other types of dementia.
Alfredo Sadun, MD, PhD, chief of Ophthalmology at the Doheny Eye Institute, University of California Los Angeles, shared exciting new research with the Eye Care Network during the Association for Research in Vision and Ophthalmology (ARVO) meeting on the subject of Leber hereditary optic neuropathy (LHON).
At this year's Association for Research in Vision and Ophthalmology (ARVO) meeting in Salt Lake City, Utah, Nitish Mehta, MD, shared highlights from his research documenting real-world results of aflibercept 8 mg for patients with diabetic macular oedema.
ARVO 2025: Anat Loewenstein, MD, shares data from herself and her colleagues on meeting needs of patients with diabetic retinopathy
At the American Society of Cataract and Refractive Surgeons annual meeting, Sheng Lim, MD, FRCOphth discusses the benefit of endoscopic cyclophotocoagulation for patients with primary open angle glaucoma and cataracts in the CONCEPT study
A photo of Seville, Spain, with the Congress on Controversies in Ophthalmology logo superimposed on it. Image credit: ©francovolpato – stock.adobe.com; logo courtesy COPHy
Anat Loewenstein, MD, Professor and Director, Department of Ophthalmology, Tel Aviv Medical Center, discusses the Congress on Controversies in Ophthalmology (COPHy)
Anat Loewenstein, MD, speaks about the 22nd Annual Angiogenesis, Exudation, and Degeneration Meeting in February 2025 and shares her global forecast for AI-driven home OCT
© 2025 MJH Life Sciences

All rights reserved.