Perioperative Antibiotic Perioperative Antibiotic Prophylaxis During Prophylaxis During

Phacoemulsification and IOL Phacoemulsification and IOL implantation: National Survey implantation: National Survey

in Englandin 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

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

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’

Methods

Postal survey (Dec 2008 to April 2009) Postal survey (Dec 2008 to April 2009) amongst Consultant Ophthalmologists amongst Consultant Ophthalmologists working in NHS departments in England working in NHS departments in England

To avoid bias from large eye departments, To avoid bias from large eye departments, only units with ≤ 8 Consultant Ophthalmic only units with ≤ 8 Consultant Ophthalmic Surgeons were includedSurgeons were included

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

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