Topical antibiotic prophylaxis before intravitreal injections: a pilot study

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 261; no. 10; pp. 2953 - 2959
• Main Authors: Trovato Battagliola, Edoardo, Riveros Cabral, Rodolfo Javier, Manco, Gregorio, Puggioni, Gianluca, Brancato, Claudio, Mangiantini, Pietro, Testa, Floriana, Malvasi, Mariaelena, Raponi, Giammarco, Turchetti, Paolo, Pacella, Fernanda, Pacella, Elena
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2023; Springer Nature B.V
• Subjects: Antibiotics; Chloramphenicol; Conjunctiva; Disease prevention; Iodine; Medical Ophthalmology; Medicine; Medicine & Public Health; Netilmicin; Ophthalmology; Ozone; Polyvinylpyrrolidone; Povidone; Povidone-iodine; Prophylaxis; Statistical analysis; Sterility; Antibiotic prophylaxis; Endophthalmitis; Intravitreal injections; Antibiotic resistance
• ISSN: 0721-832X; 1435-702X; 1435-702X
• DOI: 10.1007/s00417-023-06113-1

Purpose To explore whether topical antibiotic prophylaxis in patients scheduled for intravitreal injections achieves surface sterility in a greater proportion of subjects as compared to povidone-iodine alone. Material and methods A randomized, triple-blind clinical trial. Population: patients scheduled for intravitreal injections for maculopathy. Inclusion criteria: any sex and race, age 18 years and above. Subjects were randomized into 4 groups: the first group applied chloramphenicol (CHLORAM), the second netilmicin (NETILM), the third a commercial ozonized antiseptic solution (OZONE), and the fourth applied no drops (CONTROL). Outcome variable: percentage of non-sterile conjunctival swabs. Specimens were collected before and after the application of 5% povidone-iodine moments before the injection. Results Ninety-eight subjects (33.7% females, 64.3% males), mean age: 70.2 ± 9.3 years (54–91). Before povidone-iodine, both the CHLORAM and NETILM group showed a lower percentage of non-sterile swabs (61.1% and 31.3% respectively), as compared to the OZONE (83.3%) and CONTROL (86.5%) groups ( p  < .04). However, this statistical difference was lost after the application of povidone-iodine for 3 min. Percentage of non-sterile swabs in each group after applying 5% povidone-iodine: CHLORAM 11.1%, NETILM 12.5%, CONTROL 15.4%, OZONE 25.0%. This was not statistically significant ( p  > .05). Conclusions Topical antibiotic prophylaxis with chloramphenicol or netilmicin drops decreases the bacterial load on the conjunctiva. However, after the application of povidone-iodine, all groups showed a significant reduction in the percentage of non-sterile swabs, and this value was comparable among all groups. For this reason, authors conclude that povidone-iodine alone is sufficient and prior topical antibiotic prophylaxis is not indicated.