Intravitreal antibiotics: Accuracy of dilution by pharmacists, ophthalmologists, and ophthalmic assistants, using three protocols

We compared the accuracy with which general ophthalmologists, pharmacy personnel, and ophthalmic assistants diluted intravitreal antibiotics, using a method of their own devising, a new protocol using an insulin syringe, and Duane's protocol. The insulin syringe method proved less accurate and more complex than Duane's protocol, but was better than not using a standardized protocol at all. With all methods, the pharmacy personnel produced the most accurate dilutions, with the least variability. The ophthalmologists' dilutions were much more variable both without a protocol and with the insulin syringe method, but they were acceptable with the Duane's protocol. The ophthalmic assistants produced unacceptable results with all methods. Since the decision to inject antibiotics is usually made under emergency conditions, when errors of dilution are more likely, whenever possible, pharmacy personnel should be entrusted with providing the dosage of medications to be injected intraocularly. If pharmacists are unavailable, ophthalmologists may reconstitute medications using a reliable and simple protocol such as Duane's.