infectious disease header

Infection
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.

Images

Conjunctivitis

References - Infectious Disease Section
Infectious Disease References

Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.
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