Intracameral cefuroxime helps prevent endophthalmitis

Intracameral cefuroxime can help prevent endophthalmitis after cataract surgery and does so cost-effectively, according to Spanish researchers who conducted a systematic literature review. The researchers also found that moxifloxacin, although promising, lacks literature that confirms its efficacy or cost-effectiveness for this indication. The study was published in Clinical Ophthalmology.

The researchers searched the bibliographical databases MEDLINE and PreMEDLINE, EMBASE, CINAHL, CRD and CENTRAL of the Cochrane Library (up to October 2010); the search was updated on MEDLINE and PreMEDLINE until January 2013.

The outcomes they looked at were the onset of endophthalmitis after cataract surgery and the cost-effectiveness ratio of using either cefuroxime or moxifloxacin. The cost-effectiveness ratio takes into account factors such as the cost of the therapy and the costs avoided in cases of endophthalmitis prevented by using the antibiotic.

Included in the analysis were a clinical trial, six observational studies and an economic evaluation. All of the studies assessed cefuroxime compared with either a different antibiotic prophylaxis, or no prophylaxis.

According to the researchers, intracameral cefuroxime was found to be significantly more effective than the use of a topical antibiotic - or not using prophylaxis at all - in a randomized controlled trial performed by the European Society of Cataract and Refractive Surgery. The observational studies supported this result.

In the economic evaluation, intracameral cefuroxime showed the best cost-effectiveness ratio compared to different prophylaxis regimens.

The researchers cautioned that they found a low number of papers that complied with the selection criteria for this review, and urged further large-scale randomized controlled trials to compare the different regimens.

"This systematic review gives favourable results for the prophylactic use of intracameral cefuroxime at the end of cataract surgery," they wrote. "Regarding the use of moxifloxacin as an alternative to cefuroxime for this same indication, there is no valid information that confirms its effectiveness or cost-effectiveness, for which reason it is regarded as a promising antibiotic that requires further investigation."

To access the full study, click here.