|
|
| Eye |
Possible
therapeutic alternatives |
| Blepharitis
(eyelid) |
Common
pathogens |
(Topical
ointment ) bacitracin or erythromycin applied 2 to 4 times per
day. Clean eyelid daily.
|
| Conjunctivitis: |
Common
pathogens |
| Erythromycin
(Ilotycin): ½" of ointment q3-4h or bid-qid.
[ointment 0.5%] or |
| Gentamycin
(Garamycin): 1-2 drops every 2-4 hours or ½" ointment bid-tid.
[0.3% oint/soln] or |
| Neosporin
( neomycin, bacitracin, polymyxin): 1-2 drops q1-6h or
½" oint q3-4h. or |
| Polytrim
( 1 mg trimethoprim/ polymyxin B sulfate 10,000 units): mild
to moderate infections, instill 1 drop q3h (maximum of 6
doses per day) x 7 to 10 days. |
Sulfacetamide
(Bleph-10, Sulamyd):
Instill 1-2 drops every 2-3 hours
initially. Dosages may be tapered by increasing the time
interval between doses as the condition responds (e.g. qid). Usual
duration: 7-1 0 days. or ½" ointment q3-8h. |
Tobramycin
(Tobrex):
Solution: mild to moderate 1-2 drops q4h.
Severe infections, instill 2 drops into the eye(s)
hourly until improvement, following which treatment should
be reduced prior to discontinuation. |
| TobraDex
(Tobra + dexamethasone): 1-2
drops every 2 to 6 hours or ½" ointment 2 to 4 times
daily. |
Ciprofloxacin
(Ciloxan).
Corneal ulcers:
2 drops q15 minutes x six hours, then 2 drops every 30
minutes for the remainder of the first day. Day #2:
instill 2 drops in the affected eye hourly. Day 3rd -14th: ,
place 2 drops in the affected eye q4h. Treatment may
be continued after 14 days if corneal re-epithelialization
has not occurred.
Conjunctivitis:
1-2 drops every 2 hours while awake x 2 days, then 1-2 drops
every 4 hours while
awake x five days. Ointment: Apply a ½" ribbon
into the conjunctival sac tid x 2 days, then apply a
½" ribbon bid x 5 days. |
Ofloxacin
(Ocuflox):
bacterial
conjunctivitis: 1-2 drops q2-4 hours x 2
days, then Instill 1-2 drops four times daily x
5 days.
Corneal ulcers/keratitis:
Instill 1-2 drops every 30 minutes, while awake. Awaken at
approximately 4 and 6 hours after retiring and instill 1-2
drops x 2 days. Then Instill 1-2 drops hourly, while awake x
5 days. Then Instill 1-2 drops, four times daily x 3 days. |
|
| Keratitis
(Cornea) H.Simpex |
|
Trifluridine
(Viroptic): 1 drop q1h (9 times per day) for up to 21 days.
|
Keratitis
(varicella-zoster) |
|
Famciclovir
500mg po tid or Valacyclovir 1 gram po tid or Acyclovir
800mg po 5 times per day.
|
Vision-
threatening bacterial infection
>1.5 mm diameter ulcer, other. |
|
Fortified
ophthalmic drops
(Topical)
Usual
regimen: Fortified tobramycin or gentamicin (14-15
mg/ml) q1h alternating with [ fortified Ancef
(50 mg/ml) or Vancomycin (25-50mg/ml)
q1h. ]
|
| Fortified
Ancef (Cefazolin) (50 mg/ml): |
| Reconstitute 1
gram cefazolin powder with 5ml (200mg/ml) sterile water
(without preservative) or reconstitute 500mg vial with 2.5
ml. Then you may use any of the following dilutions:
Add 1 ml to 3 ml artificial
tears. Final concentration: 50 mg/ml. Refrigerate. Reported
stability: 4-7 days.
Add 2 ml to 6 ml of
artificial tears. Final concentration: 50 mg/ml.
Refrigerate. Reported stability: 4-7 days.
Add 4 ml to 12 ml artificial
tears. Final concentration: 50 mg/ml. Refrigerate. Reported
stability: 4-7 days.
(Side note: when adding the
cefazolin to the artificial tears, aseptically remove the
dropper head in a laminar flow hood. Do not attempt to use a
needle through the dropper head, which may alter the
intended drop size).
Alternative: Dilute
500mg vial of cefazolin powder with 10 ml sterile water. Label:
Final concentration: 50 mg/ml. Refrigerate. Stability: 7
days.
|
| Fortified
Gentamicin or Tobramycin: (Usual concentration: 14 mg/ml): |
Start with the
commercially available solution: Gentamicin 0.3% 5ml (15
mg/5 ml) ophthalmic solution or Tobramycin 0.3% 5ml (15 mg/5
ml) ophthalmic solution (. Add 2 ml of gentamicin or
tobramycin injection (80mg/2ml) to the respective ophthalmic
solution. Label:
Concentration: 14 mg/ml.
REFRIGERATE,
Expires: 7 days.
(Side note: when adding the
tobramycin or gentamicin to the respective container,
aseptically remove the dropper head in a laminar flow hood.
Do not attempt to use a needle through the dropper head,
which may alter the intended drop size).
|
| Vancomycin
ophthalmic drops |
| (Usual
concentration: 25-50 mg/ml). Some studies have found the 25
mg/mL concentration to have similar efficacy compared to the
50mg/ml concentration and with better patient tolerance.
Preparation (50
mg/ml): Reconstitute 500mg Vancomycin powder with 10 ml
sterile water (without preservative). Alternatively, use
10ml of artificial tears. Label:
Concentration: 50 mg/ml,
REFRIGERATE;
Expires: 4 days.
Dosing: (Adult Dose) 1
drop hourly for first 24 hours, then taper gradually
according to clinical improvement
|
|
|
|
| Ocular
Decongestants/ Anti-Allergy. |
| Cromolyn
sodium (Crolom): |
vernal
conjunctivitis, keratitis, and keratoconjunctivitis 1-2 drops in each
eye, 4-6 times daily, at regular intervals. |
| Ketotifen
Fumarate Ophthalmic Solution 0.025% (Zaditen) |
Allergic
conjunctivitis: 1 drop bid, (q8-12 hours). (non-competitive
histamine antagonist and mast cell stabilizer) |
| Levocabastine
(Livostin): |
Allergic
conjunctivitis 1 drop in affected eye BID-QID. [susp:
0.05%] (Antihistamine) |
| Lodoxamide
tromethamine (Alomide): |
Vernal
keratoconjunctivitis. Dosing: 1-2 drops four times daily. [soln: 0.1%]
Cromolyn-like action. |
| Naphazoline
(Naphcon, Vasocon): |
Ocular
decongestant. Dosing: 1 drop every 3 to 4 hours as needed up to
4 times daily. |
| Vasocon-A
antazoline phosphate (0.5%), naphazoline hydrochloride (0.05%) |
Antihistamine/decongestant:
Dosing: 1-2 drops 2 to 4 times daily as needed. |
| Olopatadine
(Patanol): |
Allergic
conjunctivitis: 1-2 drops twice daily. [0.1% soln] (selective H1-receptor antagonist and mast-cell release inhibitor) |
| Pemirolast
(Alamast): |
Allergic
conjunctivitis: 1-2 drops qid. |
|
Antimicrobial
Series
References |
| American
Hospital Formulary Service. Drug Information. Bethesda, MD: ASHP,
1997.
|
Baden LR, Eisenstein BI.Impact of
Antibiotic Resistance on the Treatment of Gram-negative Sepsis.
Curr Infect Dis Rep. 2000 Oct;2(5):409-416. |
| Bartlett JG et al.
Community-acquired pneumonia in adults: guidelines for management.
Guidelines from the Infectious Diseases Society of America. Clin Infect
Dis. 1998;26:811-38. |
| Bartlett JG: Empirical therapy of
community-acquired pneumonia: macrolides are not ideal choices. Semin
Respir Infect 1997 Dec; 12(4): 329-33 |
| Bartlett JG.1998 Pocket Book of
Infectious Disease Therapy., Ninth Edition. Baltimore,MD:
Williams&Wikins,1998. |
| Bernstein JM: Treatment of
community-acquired pneumonia--IDSA guidelines. Infectious Diseases
Society of America. Chest 1999 Mar; 115(3 Suppl): 9S-13S |
| Drug Information Handbook, 5th Ed.
1997, Lexi-Comp inc. |
| Ewig S et al. Pneumonia acquired
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Respir Crit Care Med. 1999;159:1835-42. |
| File TM Jr. Community-acquired
pneumonia: recent guidelines for therapy. J Respir Dis. 1999;20:534-41. |
| Gilbert DN, Moellering RC, Sande
MA. The Sanford Guide to Antimicrobial Therapy 2000. 30th ed. Hyde
Park,VT: Antimicrobial Therapy, Inc.; 2000. |
| Gold HS, Moellering RC.
Antimicrobial-drug resistance. N Engl J Med. 1996;335:1445-1453. |
| Gonzales R, Sande M: What will it
take to stop physicians from prescribing antibiotics in acute
bronchitis? Lancet 1995 Mar 18; 345(8951): 665-6 |
| Hooton TM, Stamm WE. Diagnosis and
treatment of uncomplicated urinary tract infection. Infect Dis Clin
North Am 1997;11:551-581. |
Lipsky BA, Berendt AR.Principles
and practice of antibiotic therapy of diabetic foot infections.
Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6. |
Mufson MA.Pneumococcal Pneumonia.
Curr Infect Dis Rep. 1999 Apr;1(1):57-64. |
| Reese RE, Betts
RF: A Practical
Approach to Infectious Diseases. 4th ed. Boston: Little, Brown, and
Company; 1996: 251 |
Stefani SD, Cadore LP, Villaroel
RU, Azevedo S, Machado AL. Antibiotic Selection in the Treatment of
Febrile Neutropenia: Current Approach and New Directions.
Braz J Infect Dis. 1998 Jun;2(3):109-117. |
|
Stamm WE, Hooton TM. Management of urinary tract infections in adults. N
Engl J Med 1993;329:1328-1334. |
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