A 72-year-old woman presents 8 days after uncomplicated phacoemulsification with sudden onset pain, redness, decreased vision to counting fingers, and hypopyon. The most likely organism is Staphylococcus epidermidis. Which intravitregal antibiotic combination is the FIRST-LINE empiric treatment for suspected post-cataract surgery endophthalmitis?

• A Intravitreal gentamicin alone
• B Intravitreal ceftriaxone alone
• C Intravitreal clindamycin plus intravitreal amphotericin B
• D Intravitreal vancomycin plus intravitreal ceftazidime ✓

Explanation

The standard empiric intravitreal regimen for suspected bacterial endophthalmitis is vancomycin (1 mg/0.1 mL) for gram-positive coverage and ceftazidime (2.25 mg/0.1 mL) for gram-negative coverage. This is the regimen recommended by the ESCRS and widely followed in India. Ceftriaxone does not achieve reliable intravitreal levels. Gentamicin carries retinal toxicity risk and has been largely replaced by ceftazidime. Amphotericin D is for fungal endophthalmitis, not empiric bacterial coverage.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.