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Editor,—The recommended treatment of endophthalmitis includes intravitreal injection of broad spectrum antibiotics. Vancomycin is the drug of choice for Gram positive bacteria, while Gram negative coverage can be obtained by either amikacin or ceftazidime. Owing to potential retinal toxicity with amikacin, the option of its substitution by ceftazidime seemed very attractive.1-7
Fiscella,8 and the pharmacological handbooks have already described physical incompatibility of vancomycin and ceftazidime.9 10 We encountered this phenomenon in two cases of post-traumatic endophthalmitis, which were treated with intravitreal vancomycin and ceftazidime. Immediately upon injection the antibiotics were seen to form yellow-white precipitates along the needle tract.
CASE REPORTS
Case 1
A 17 year old male was treated for post-traumatic endophthalmitis. Following anterior chamber and vitreous tap and cultures, intravitreal ceftazidime 2.2 mg/0.1 ml and vancomycin 1 mg/0.1 ml were slowly injected, as well as subconjunctival injection ceftazidime 100 mg/0.5 ml and vancomycin 25 mg/ 0.25 ml. This was done using different needles and syringes for each drug. Immediately upon injection dense yellow-white precipitates were observed along the …