Hematogenous
- Insidious onset.
- Sources/risk factors:
- endocarditis
- urinary tract infections
- abdominal (e.g. liver) abscesses
- pneumonia
- immunosuppression
- chronic injection drug use
- gastrointestinal procedures (e.g. endoscopy)
- TPN
- central venous catheters
- Blood cultures should be taken.
- Vitrectomy may be required.
- IV antibiotics required for systemic infection (tailor antibiotics according to C&S results).
Usual Pathogens
Streptococcus spp
N. meningitidis
S. aureus
Bacillus cereus
Candida spp
Ophthalmic Preparations
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin 1mg/0.1mL | 0.1mL intravitreally | Dependent on clinical picture |
| + | ||
| Ceftazidime 2.25mg/0.1mL | 0.1mL intravitreally |
ß-lactam allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin 1mg/0.1mL | 0.1mL intravitreally | Dependent on clinical picture |
| + | ||
| [Gentamicin 0.2mg/0.1mL | 0.1mL intravitreally | |
| or | ||
| Amikacin 0.4mg/0.1mL] | 0.1mL intravitreally |
+
Systemic Antibiotics
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 2g IV q12h | 6 weeks, dependent on culture results |
| + | ||
| Vancomycin | 15mg/kg IV q8-12h |