Endophthalmitis Therapy

To the Editor.  —The article by Dr Diamond entitled "Intraocular Management of Endophthalmitis: A Systematic Approach" in the Archives (1981;99:96-99) presents what he considers a systematic approach to the treatment of bacterial endophthalmitis. His standard therapy consists of a single intravitreal injection of 300 μg of gentamicin sulfate and 2 mg of methicillin sodium. The only other antibiotics administered are subconjunctival injections of gentamicin and methicillin at surgery, which are repeated 72 hours later, and oral cephalothin sodium. In writing this letter, we would like to stress the following points.

1. On the basis of experimental and clinical studies, there seems to be little or no reason to support the use of oral antibiotics to treat endophthalmitis,¹ because the systemic levels produced would not usually offer any appreciable benefit. Cephalothin, which was administered orally by Dr Diamond, shows almost no systemic absorption by this route. In unusual circumstances, agents such as