Prophylactic use of azithromycin for the prevention of posttraumatic endophthalmitis

Background. Post-traumatic endophthalmitis (PTE) is a severe infectious complication of ocular trauma associated with a high risk of vision loss. In the absence of standardized outpatient prevention protocols for PTE, the selection of an effective topical antibacterial agent remains relevant. Azithromycin, possessing both antimicrobial and anti-inflammatory properties, is considered a potentially effective drug as part of combination therapy. Purpose: to evaluate the effectiveness of topical azithromycin (“Azibakta”) for the prevention of post-traumatic endophthalmitis (PTE) in patients with ocular injuries. Materials and methods. The study included 46 patients with penetrating and non-penetrating ocular injuries, divided into two groups: the main group (n = 23) received azithromycin 15 mg/g (“Azibakta”), and the control group (n = 23) received ciprofloxacin 0.3% (“Ciprofloxacin Renewal”). Both groups were administered standard anti-inflammatory therapy. The primary outcome was the incidence of PTE within 14 days; secondary outcomes included inflammation dynamics and changes in best-corrected visual acuity (BCVA). Results. No cases of PTE were observed in the azithromycin group, whereas three cases (13.0%) occurred in the ciprofloxacin group (p = 0.038). Microbiological cultures performed in these patients identified Staphylococcus epidermidis in two cases—sensitive to vancomycin and gentamicin but resistant to fluoroquinolones—and Bacillus cereus in the third case, a highly virulent, multidrug-resistant organism susceptible to macrolides including azithromycin. These findings support the rationale for azithromycin as a prophylactic agent in high-risk ocular trauma. Azithromycin treatment also resulted in significantly faster reduction of inflammatory signs (corneal edema, conjunctival injection, discharge) and greater improvement in best corrected visual acuity (BCVA), which increased from 0.52 ± 0.38 at admission to 1.24 ± 0.52 at two weeks. No adverse effects were reported. Conclusion. Topical azithromycin administration in patients with ocular injuries reduces the risk of developing PTE and accelerates the resolution of inflammatory symptoms. These findings support its potential as a component of emergency antibiotic prophylaxis for various types of ocular trauma.

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