rifampin and Endophthalmitis

Rifampicin encapsulated microparticles were designed for intraocular injection after cataract surgery to prevent postoperative endophthalmitis. Microparticles were formulated by emulsification diffusion method using poly(lactic acid-co-glycolic acid) (PLGA) as polymer in order to propose a new form of rifampicin that overcome its limitations in intraocular delivery. Depending on processing formulation, different types of microparticles were prepared, characterized and evaluated by in vitro release studies. Two types of microparticles were selected to get a burst release of rifampicin, to reach minimal inhibitory concentrations to inhibit 90% of Staphylococcus epidermidis mainly involved in postoperative endophthalmitis, combined with a sustained release to maintain rifampicin concentration over 24h. The antibacterial activity and antiadhesive property on intraocular lenses were evaluated on S. epidermidis. Microparticles, with a rapid rifampicin release profile, showed an effect towards bacteria development similar to free rifampicin over 48h. However, slow-release profile microparticles exhibited a similar antibacterial effect during the first 24h, and were able to destroy all the S epidermidis in the medium after 30h. The association of the two formulations allowed obtaining interesting antibacterial profile. Moreover, rifampicin-loaded microparticles have shown a very efficient anti-adherent effect of S. epidermidis on intraocular lenses at 24h. These results propose rifampicin microparticles as suitable for antibioprophylaxis of the postoperative endophthalmitis.

Topics: Anti-Bacterial Agents; Bacterial Adhesion; Chemistry, Pharmaceutical; Delayed-Action Preparations; Drug Carriers; Drug Delivery Systems; Drug Liberation; Endophthalmitis; Lactic Acid; Microbial Sensitivity Tests; Microspheres; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Time Factors

Endogenous endophthtalmitis is an intraocular infection of hematogenous origin.. It is generally a panuveitis that may be mixed-up with a non-infectious inflammatory disease, promoting delayed treatment and compromising the visual prognosis, as the visual loss rate reaches up to 37.5%. Antibiotherapy should be started immediately after bacteriological examinations and without waiting for vitrectomy. Identification of the causative microorganism is absolutely necessary. It may require aqueous or vitreous culture if cultures from other body fluids are negative and infection progresses. The most common infections are endocarditis and digestive and renal diseases. Virectomy is indicated for first line treatment of ocular abcess and improvement of antibiotic absorption. However, it may lead to retinal detachment. Vitrectomy is also indicated in case of unsuccessful therapy. To decrease the inflammatory reaction and risks of vitreous organization, local or systemic corticotherapy is prescribed after control of the infection.. Although rare, endogenous endophthalmitis should be diagnosed as it may be mixed-up with inflammatory uveitis, leading to inappropriate corticotherapy. Furthermore, antibiotherapy with good intraocular penetration should be started immediately, but it should be kept in mind that the functional prognosis is poor.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Flucytosine; Humans; Male; Middle Aged; Ofloxacin; Oxacillin; Rifampin; Staphylococcal Infections; Vitrectomy

Candida endophthalmitis, caused by transient candidemia, developed in a 14-year-old white girl receiving intravenous hyperalimentation. Antifungal synergism was established in vitro for the combination of amphotericin B and rifampin against the C. albicans isolate. A combined ten-day course of intravenous amphotericin B and oral rifampin was followed by the elimination of the infection and the preservation of good visual acuity.

Topics: Administration, Oral; Adolescent; Amphotericin B; Candida albicans; Candidiasis; Catheterization; Endophthalmitis; Female; Humans; Injections, Intravenous; Rifampin; Visual Acuity