Antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy: A decision-making algorithm

  • Benjamin R. LaHood
    Correspondence
    Corresponding author: Benjamin R. LaHood, FRANZCO, The Queen Elizabeth Hospital, Woodville Road, Adelaide, South Australia, Australia.
    Affiliations
    The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

    South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia

    University of Adelaide, Adelaide, South Australia, Australia
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  • Nicholas H. Andrew
    Affiliations
    The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

    South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia

    University of Adelaide, Adelaide, South Australia, Australia
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  • Michael Goggin
    Affiliations
    The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

    South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia

    University of Adelaide, Adelaide, South Australia, Australia
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      Abstract

      Cataract surgery is the most commonly performed surgical procedure in many developed countries. Postoperative endophthalmitis is a rare complication with potentially devastating visual outcomes. Currently, there is no global consensus regarding antibiotic prophylaxis in cataract surgery despite growing evidence of the benefits of prophylactic intracameral cefuroxime at the conclusion of surgery. The decision about which antibiotic regimen to use is further complicated in patients reporting penicillin allergy. Historic statistics suggesting crossreactivity of penicillins and cephalosporins have persisted into modern surgery. It is important for ophthalmologists to consider all available antibiotic options and have an up-to-date knowledge of antibiotic crossreactivity when faced with the dilemma of choosing appropriate antibiotic prophylaxis for patients undergoing cataract surgery with a history of penicillin allergy. Each option carries risks, and the choice may have medicolegal implications in the event of an adverse outcome. We assess the options for antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy and provide an algorithm to assist decision-making for individual patients.

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