Perioperative Antibiotic Prophylaxis During Phacoemulsification and IOL implantation: National Survey in England

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Perioperative Antibiotic Prophylaxis During
Phacoemulsification and IOL implantation
National Survey in England

• Michael J. Wearne BSc (Hons), FRCOphth
• Eastbourne District General Hospital, Eastbourne,
  United Kingdom
• Mayank A. Nanavaty DO, MRCOphth, MRCS(Ed)
• Queen Victoria Hospital, East Grinstead, United
  Kingdom
• None of the authors have any financial or
  proprietary interest in any product or procedure
  mentioned

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Introduction

• Despite ESCRS guidelines in 2007 recommending
• intracameral Cefuroxime there still seems to be
  a wide variation in practice in England
• 10 cross reactivity myth between Pencillins and
  Cephalosporins was generated by old reports using
  Penicillins which were manufactured from
  Cephalosporium mold.
• For the patients truly allergic to Penicillin the
  risk of reaction to Cefuroxime with a different
  side chain is so low that it can be justified and
  medico-legally defendable in the light of current
  scientific evidence

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Study Aims

• To ascertain current practice with regards to
  antibiotic prophylaxis by Consultants in England
  during cataract surgery
• To determine the choice of antibiotic when the
  patient is labelled to have penicillin allergy

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Methods

• Postal survey (Dec 2008 to April 2009) amongst
  Consultant Ophthalmologists working in NHS
  departments in England
• To avoid bias from large eye departments, only
  units with 8 Consultant Ophthalmic Surgeons
  were included

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Results

• Total 401 Consultants work in department with 8
  Consultants
• The questionnaire was sent to all 401 Consultant
  Ophthalmic Surgeons and 262 Consultants (65)
  replied

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Conclusions

• There is a wide variation in the use of
  prophylactic antibiotics and its route of
  administration
• ESCRS recommendations do seem to have resulted in
  a trend towards using intracameral Cefuroxime
  (45 in our study compared to only 9 pre
  guidelines)
• In penicillin allergy only a third used
  Cefuroxime, with nearly half switching to
  Gentamicin
• This survey highlights the reluctance of using
  Cefuroxime in patients allergic to penicillin
  despite evidence to the contrary