"Through the entire process, nothing is exposed to the air. However,
it's not a problem to discard all but one dose per vial given that the
cost per patient is so minimal." Dr. Zudans buys his cefuroxime pow-
der from Hikma Pharmaceuticals for $1.08 per vial. When the cost of
saline and syringes is added, the cost per patient is around $2, he says.
No matter which drug or preparation option you choose, keep in
mind that the simple reconstitution or diluting of a product immedi-
ately before patient use follows Joint Commission standards.
"The current definition of admixing or compounding for the ambula-
tory program is when 2 or more ingredients are combined together
with a volume greater than 50mL," says Robert Campbell, PharmD,
interim senior associate director pharmacist, standards interpretation,
with The Joint Commission. "It's suggested that products prepared
outside of a properly tested and certified compounding hood should
be prepared and administered as quickly as possible and should never
exceed 1 hour from the time of preparation until the start of adminis-
tration."
A trend likely to continue
Many industry insiders predict that more and more U.S. surgeons will
adopt intracameral antibiotics for cataract surgery. An ASCRS study
known as TIME — "topical versus intracameral moxifloxacin for
endophthalmitis prophylaxis" — could speed the adoption rate. The
multicenter, prospective, randomized controlled trial, set to begin in
around 6 months, will test whether unit doses of moxifloxacin
designed for intracameral injection are more effective than topical
administration.
"If intracameral moxifloxacin is shown to be superior, we'll seek
FDA approval of the formulation," says ophthalmologist Eric D.
Donnenfeld, MD, FACS, of Ophthalmic Consultants of Long Island
9 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
