Coupling topical antibiotic with intravitreal injections is not just unnecessary, according to investigators, it’s dangerous.1

The opinion, published in Acta Ophthalmology, outlines the principles of antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis.1 The investigators say they’ve uncovered increasing evidence that topical antibiotics, given before or after intravitreal injections, are ineffective in preventing endophthalmitis.1 In fact, they suggest, the potential for infection is extremely low—0.02% to 0.1%—due in part to the small-gauge of the needles used in these procedures.1,2 In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Finally, the investigators emphasize that the topical application of antibiotics is likely to lead to future resistance. Instead, they stress antiseptic and asepsis techniques for prevention of endophthalmitis.

This conclusion supports 2014 recommendations in the United States, “but in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics,” according to the report.3

1. Hunyor A, Merani R, Darbar A, et al. Topical Antibiotics and intravitreal injections. Acta Ophthalmol. 2018;96(5):435-41.

2. Chen R, Rachitskaya A, Scott I, et al. Is the use of topical antibiotics for intravitreal injections the standard of care of are we better off without antibiotics? JAMA Ophthalmol. 2013;131(7):840-2.

3. McCannel C, Flynn H, Cunningham E. Updated guidelines for intravitreal injections. Rev Ophthalmol. 2015;22(7):52-55.