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

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)

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

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  1. 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

  2. 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

  3. 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’

  4. 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

  5. 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

  6. 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

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