Clinical Ophthalmology Open Access Full Text Article Topical azithromycin or ofloxacin for endophthalmitis prophylaxis after intravitreal injection Dovepress open access to scientific and medical research O R I G I n A L R E S E A R C H Pedro Romero-Aroca1 Laura Sararols2 Lluis Arias3 Ricardo P Casaroli-Marano4 Francisca Bassaganyas5 1Department of Ophthalmology, Hospital Universitari Sant Joan, Universidad Rovira i Virgili, Reus, 2Department of Ophthalmology, Hospital de Granollers, Granollers, 3Department of Ophthalmology, Hospital Universitari de Bellvitge, Barcelona, 4Instituto Clínico de Oftalmologia, Hospital Clínic de Barcelona, Barcelona, 5Department of Ophthalmology, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain Correspondence: Pedro Romero-Aroca Department of Ophthalmology, Hospital Universitari Sant Joan, Universidad Rovira i Virgili, Av del Dr Josep Laporte, 2 43204 Reus, Spain Tel +34 977 310 300 ext 5308 Fax +34 977 323 754 Email romeropere@gmail.com Background: The number of patients who have undergone intravitreal injections has increased enormously in recent years, but a consensus is still lacking on prophylaxis for endophthalmitis. The aim of this prospective, observational study was to evaluate the prophylactic effect of azithromycin eye drops versus ofloxacin eye drops. Methods: The study was conducted in five hospitals in Spain and included all patients under- going intravitreal injections of triamcinolone, bevacizumab, ranibizumab, or pegaptanib over one year. Patients received azithromycin 15 mg/g eye drops (twice daily on the day prior to injection and for another 2 days) or ofloxacin 3 mg/g eye drops (every 6 hours on the day prior to injection and for another 7 days). Results: In the azithromycin group, there were 4045 injections in 972 eyes of 701 patients. In the ofloxacin group, there were 4151 injections in 944 eyes of 682 patients. There were two cases of endophthalmitis (0.049%) in the azithromycin group and five (0.12%) in the ofloxacin group. The odds ratio of presenting with endophthalmitis in the ofloxacin group compared with the azithromycin group was 2.37 (95% confidence interval [CI] 1.32–3.72, P , 0.001). There were two cases of noninfectious uveitis after triamcinolone injection in the azithromycin group (0.049%) and two (0.048%) in the ofloxacin group; no significant differences were observed (odds ratio 0.902, 95% CI 0.622–1.407, P = 0.407). Conjunctival hyperemia was observed in 12 cases in the azithromycin group and none in the ofloxacin group. Conclusion: The risk of endophthalmitis was significantly greater with ofloxacin than with azithromycin. These findings provide a valuable addition to the ever-increasing pool of infor- mation on endophthalmitis prophylaxis after intravitreal injection, although further large-scale studies are required to provide definitive conclusions. Keywords: endophthalmitis prophylaxis, intravitreal injections, azithromycin, ofloxacin, antibiotics Introduction The number of patients who have undergone intravitreal injections has increased enormously in recent years, partly due to the greater number of pathologies in which these injections are indicated (diabetic retinopathy, age-related macular degeneration, diabetic or retinal venous occlusion, macular edema, or uveitis) and partly because of the growing number of available drugs that can be administered in this way.1 Intravitreal antibiotics were first used at the end of the 1990s and early in the new millennium, and new drugs are constantly being commercialized for intravitreal injection, such as corticosteroids and anti-vascular endothelial growth factor agents. In the coming years, more new drugs will likely become available; slow-release drugs such as fluocinolone submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/OPTH.S35795 Clinical Ophthalmology 2012:6 1595–1599 1595 © 2012 Romero-Aroca et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.