Are Prophylactic Systemic Antibiotics Required in Patients with Cataract Surgery at Local Anesthesia?

Toshihiko Matsuo (), Masahiro Iguchi, Noriyasu Morisato, Tatsuya Murasako and Hideharu Hagiya
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Toshihiko Matsuo: Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan
Masahiro Iguchi: Department of Pharmacy, Ochiai Hospital, Maniwa 719-3197, Japan
Noriyasu Morisato: Department of Pharmacy, Ochiai Hospital, Maniwa 719-3197, Japan
Tatsuya Murasako: Clinical Laboratories, Ochiai Hospital, Maniwa 719-3197, Japan
Hideharu Hagiya: Department of General Medicine, Okayama University Hospital, Okayama 700-8558, Japan

IJERPH, 2022, vol. 19, issue 23, 1-8

Abstract: The reduced use of antimicrobial drugs has been recommended worldwide, according to the global action for antimicrobial resistance published in 2015 by the World Health Organization. In this study, we retrospectively reviewed the incidence of surgical site infection in consecutive patients with cataract surgeries at a single hospital in the 6-year process when prophylactic systemic antibiotics were reduced in a step-by-step manner. The entire study period from 2016 to 2022 was divided into five stages, based on the use of systemic antibiotics. In stage 1 with 649 cataract surgeries, an intravenous drip infusion of cefazolin 1 g was given at surgery, followed by oral cefdinir 100 mg in the evening on surgery day and three times for two postoperative days. In stage 2 with 541 cataract surgeries, oral cefdinir 100 mg was given in the late morning before surgery, in the evening, and three times (300 mg in total) for two postoperative days. In stage 3 with 103 cataract surgeries, oral levofloxacin 500 mg was given in the late morning before surgery and once in the morning for two postoperative days. In stage 4 with 545 cataract surgeries, oral levofloxacin 500 mg was given only in the late morning before surgery. In stage 5 with 311 cataract surgeries, no systemic antibiotics were given. As common procedures in all stages, moxifloxacin eye drops were given four times daily as topical antibiotics in the 3 days before surgery and about 2 weeks after surgery. At surgery, the ocular surface was frequently irrigated with saline-diluted povidone iodine at 0.5% working concentration. No postoperative infection was recorded in any stage. This study showed neither harm nor risk in reduced use and, consequently, no use of prophylactic systemic antibiotics in cataract surgery as far as local precautionary measures were secured.

Keywords: cataract surgery; global action plan; antimicrobial resistance; appropriate use; antibiotics; oral; intravenous; topical; povidone iodine; conjunctival sac culture (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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