Editorial calls for study of financial aspects of antibiotic use

This editorial urges consideration of the costs of antibiotics for endophthalmitis prevention after cataract surgery. While nearly every patient undergoing cataract surgery in the United States receives topical antibiotics before and after surgery, infections still occur. Some evidence even suggests infection rates are on the rise. With approximately 3 million cataract surgeries performed each year in the United States, drug expenditures for the procedure are significant. Because most efforts to prevent endophthalmitis are based on clinical experience and less-than-ideal clinical trials, the author says there is a compelling need to better understand the role of antibiotics in the prevention of complications after cataract surgery.

While the large cost of randomized, clinical trials is often cited as a hindrance, the author says the cost of continuing our current approach is almost certainly far greater. To address the most pressing issues regarding antibiotics and cataract surgery, he recommends a prospective, randomized comparison of several days of topical antibiotics versus a single injection of an intracameral antibiotic after surgery. All patients in the study would receive povidone-iodine prior to surgery and have excellent closure of incisions. A third group would receive both topical and intracameral antibiotics and provide a useful comparison.

He concludes that the results of such a trial would likely guide clinical care based on evidence, not speculation. Additionally, he says that outcomes would likely improve, and health care dollars could be spent more appropriately.