Antimicrobial guide to posterior segment infections
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REVIEW ARTICLE
Antimicrobial guide to posterior segment infections Tapan P. Patel 1 & David N. Zacks 2 & Vaidehi S. Dedania 3 Received: 5 June 2020 / Revised: 8 September 2020 / Accepted: 7 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This review article is meant to serve as a reference guide and to assist the treating physician in making an appropriate selection and duration of an antimicrobial agent. Methods Literature review. Results Infections of the posterior segment require prompt medical or surgical therapy to reduce the risk of permanent vision loss. While numerous options exist to treat these infections, doses and alternative therapies, especially with contraindications for firstline therapy, are often elusive. Antimicrobial agents to treat posterior segment infections can be administered via various routes, including topical, intravitreal, intravenous, and oral. Conclusions Although there are many excellent review articles on the management of endophthalmitis, we take the opportunity in this review to comprehensively summarize the appropriate antimicrobial regimen of both common and rare infectious etiologies of the posterior segment, using evidence from clinical trials and large case series.
Key messages Early diagnosis and prompt antimicrobial therapy is essential for treating vision-threatening infections of the posterior segment Intravitreal injection of antimicrobial agents is the mainstay of therapy for a majority of infections and is supplemented with systemic therapy taking into account intraocular penetration of systemic antimicrobial agents The first-line and alternative therapies for common and rare infections of the posterior segment are summarized and concisely tabulated in this review article.
Keywords Antimicrobial . Antiviral . Antihelminthic . Choroiditis . Endophthalmitis . Infectious vitritis . Intravitreal penetration . Posterior segment . Retina . Retinitis
Introduction
* Vaidehi S. Dedania [email protected] 1
Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, MD, USA
2
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
3
Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
Infections of the vitreous, retina, or choroid (the posterior segment) require prompt treatment in order to reduce the risk of permanent vision loss. Often, the inciting organism is unknown and empiric broad-spectrum therapy is employed until a definitive microbial agent and antimicrobial susceptibilities can be determined. A prime example is endophthalmitis, where prompt broad-spectrum intravitreal antimicrobial therapy administration is imperative until the causative agent can be identified from a diagnostic aqueous or intravitreal fluid sample. Many excellent review articles exist in the literature that discuss
Graefes Arch Clin Exp Ophthalmol
the epidemiology, clinical presentation, diagnosis, and treatme
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