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Antibiotic Guidelines for Ophthalmology V1.8 290413 Issue Date Review Date Review Cycle May 2019 May 2022 Three Years Consulted with the Following Stakeholders

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Antibiotic Guidelines for Ophthalmological Indications in Secondary Care Document Control Title Antibiotic guidelines for ophthalmological indications in Adults in Secondary Care Author Author’s job title Consultant Microbiologist Consultant Ophthalmologist Pharmacist Directorate Department Diagnostics Microbiology Date Version Status Comment / Changes / Approval Issued 0.1 Jan Draft First draft for consultation. After discussion with Mr 2011 Nestel. Further discussion with Ophthalmology. Changes to prophylaxis after penetrating injury. Changes to keratitis. Change to prophylaxis for globe injury 1.0 Sep Final Approved by DTG with minor amendments. 2011 1.1 Sep Revision Minor amendments to document control report, hyperlinks 2011 to appendices, and added headers and footers. Automatic table of contents. Change of co-amoxiclav frequency for pre-orbital cellulitis. 1.3 Jan Revision Corrected hyperlinks to Vancomycin guideline in 2012 appendices. 1.4 Feb Revision Change from cefuroxime to cefotaxime for orbital cellulitis 2012 to bring into line with published guidance. 2.0 Mar Final Approved by Drug and Therapeutics Committee on 8th 2012 March 2012 with minor amendments. 2.1 Jun Revision Minor amendment by Corporate Governance to document 2012 control report. 2.2 Nov Revision Minor changes to preparations (preservative free) and 2012 dosing intervals for keratitis 2.3 Mar Revision Keratitis – changed to preservative free drops. 2013 2.4 Jun Revision Guidance split into two: treatment and surgical 2017 prophylaxis. Added acanthamoeba guidance. 3.0 May Final Reviewed with Consultant Ophthalmologist. Information for 2019 intra-vitreal preparations deleted, to refer to on-site manual in theatres. Anti-fungal guidance added for keratitis, endophthalmitis, penetrating globe injury. Clinical diagnostics information added for all indications as per updated NICE requirements for antibiotic guidelines. References updated. Approved at DTC 16th May 2019. Main Contact Consultant Microbiologist Tel: Direct Dial – Microbiology Tel: Internal – North Devon District Hospital Email: Raleigh Park Barnstaple, EX31 4JB Microbiology Page 1 of 67 Antibiotic Guidelines for Ophthalmological Indications in Secondary Care Lead Director Director of Medicine Superseded Documents Antibiotic Guidelines for Ophthalmology v1.8 290413 Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: Antibiotic Working Group Drug & Therapeutics Group Consultant Ophthalmologists Approval and Review Process Antibiotic Working Group Drug & Therapeutics Group Local Archive Reference G:\ANTIBIOTICSTEWARDSHIP Local Path G:\ANTIBIOTIC STEWARDSHIP\Stewardship\Antibiotic policies\Published policies Filename Antibiotic Guidelines for Ophthalmology v2.0 160519 Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Conjunctivitis, Pre-orbital cellulitis, Orbital Pharmacy, Microbiology, Ophthalmology cellulitis, Endogenous endophthalmitis, Exogenous endophthalmitis, Keratitis, Viral retinitis, Rosacea, Dacrocystitis, Blepharitis, Toxoplasmosis, Toxocariasis, Surgical prophylaxis Microbiology Page 2 of 67 Antibiotic Guidelines for Ophthalmological Indications in Secondary Care CONTENTS Document Control ............................................................................................................... 1 1. Purpose ........................................................................................................................ 4 2. Responsibilities ........................................................................................................... 4 3. Contacts ....................................................................................................................... 5 4. Management of Ophthalmological infections ............................................................ 5 5. Monitoring Compliance with and the Effectiveness of the Guideline ...................... 5 6. Equality Impact Assessment ....................................................................................... 6 7. References ................................................................................................................... 7 8. Associated Documentation ....................................................................................... 10 9. Appendix 1 - Blepharitis ............................................................................................ 11 10. Appendix 2 – Conjunctivitis ...................................................................................... 16 11. Appendix 3 - Dacrocystitis ........................................................................................ 19 12. Appendix 4 – Endogenous Endophthalmitis............................................................ 23 13. Appendix 5 – Exogenous Endophthalmitis .............................................................. 27 14. Appendix 6 - Keratitis ................................................................................................ 31 15. Appendix 7 – Ocular Toxocariasis ............................................................................ 38 16. Appendix 8 – Ocular Toxoplasmosis ........................................................................ 41 17. Appendix 9 – Orbital Cellulitis .................................................................................. 46 18. Appendix 10 – Penetrating Globe Injury ................................................................... 50 19. Appendix 11 – Peri-orbital (Preseptal) Cellulitis ...................................................... 54 20. Appendix 12 - Rosacea .............................................................................................. 58 21. Appendix 13 – Viral Retinitis ..................................................................................... 60 22. Appendix 14 – Acanthamoeba .................................................................................. 63 23. Appendix 15 – Intravitreal Preparation Kits – follow ESCRS endophthalmitis guidelines for intravitreal preparations in theatre kit trolley ......................................... 67 24. Surgical Procedures .................................................................................................. 67 Microbiology Page 3 of 67 Antibiotic Guidelines for Ophthalmological Indications in Secondary Care 1. Purpose 1.1. This document sets out Northern Devon Healthcare NHS Trust’s best practice guidelines for appropriate microbiological investigation and antimicrobial prescribing in adult patients with Ophthalmological infection. 1.2. This guideline applies to all adults and must be adhered to. Special considerations exist for pregnant and breastfeeding patients; liaise with specialist clinicians as appropriate in these cases. See separate guidance for paediatric patients. 1.3. Non-compliance with this guideline may be for valid clinical reasons only. The reason(s) for non-compliance must be documented clearly in the patient’s notes. 1.4. This guideline is primarily aimed at all prescribing teams but other staff (e.g. nursing staff, pharmacists) may need to familiarise themselves with some aspects of the guideline. 1.5. Implementation of this guideline will ensure that: Ophthalmological infection is managed according to current evidence and standards of practice in the wider healthcare community. A standard of care is specified to facilitate a consistent approach between ophthalmology, microbiology and pharmacy in terms of patient management, specimen processing and drug availability. 2. Responsibilities 2.1. Responsibility for education and training lies with the Lead Consultant Microbiologist for Antibiotic Stewardship. It will be provided through formal study days and informal training on the ward. 2.2. The author will be responsible for ensuring the guidelines are reviewed and revisions approved by the Drug and Therapeutics Group in accordance with the Document Control Report. 2.3. All versions of these guidelines will be archived in electronic format by the author within the Antibiotic Stewardship policy archive. 2.4. Any revisions to the final document will be recorded on the Document Control Report. 2.5. To obtain a copy of the archived guidelines, contact should be made with the author. 2.6. Monitoring of implementation, effectiveness and compliance with these guidelines will be the responsibility of the Lead Clinician for Antibiotic Stewardship. Where non-compliance is found, the reasons for this must have been documented in the patient’s medical notes. Microbiology Page 4 of 67 Antibiotic Guidelines for Ophthalmological Indications in Secondary Care Role of Antibiotic Working Group (AWG) 2.7. The AWG is responsible for: Leading antibiotic guideline development and review within Northern Devon Healthcare Trust Involving all relevant stakeholders in guideline development and review 3. Contacts 3.1. Contact numbers: Microbiologist Bleep 193. Via switchboard out of hours. Antibiotic Pharmacist Bleep 029 (Mon-Fri only) On call Ophthalmologist Via switchboard out of hours. 4. Management of Ophthalmological infections 4.1. See appendices 5. Monitoring Compliance with and the Effectiveness of the Guideline Suggested audit criteria 5.1. The following could be used: Required specimens to be sent as per guideline 100% Antibiotic (topical and systemic) used as per guideline or microbiology advice 100% Process for Implementation and Monitoring Compliance and Effectiveness 5.2. Incidents involving
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