InternPractice — Always a Step Ahead

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Eye drops ▶Emustil (Rayner Pharmaceuticals Ltd) Emustil eye drops 0.3ml unit dose preservative free | 20 unit dose £6.22 Eye infections Eye, infections Eye infections Most acute superﬁcial eye infections can be treated topically. Blepharitis and conjunctivitis are often caused by staphylococci; keratitis and endophthalmitis may be bacterial, viral, or fungal. Bacterial blepharitis is treated by application of an antibacterial eye ointment to the conjunctival sac or to the lid margins. Systemic treatment may occasionally be required and is usually undertaken after culturing organisms from the lid margin and determining their antimicrobial Eye sensitivity; antibiotics such as the tetracyclines given for 3 months or longer may be appropriate. Most cases of acute bacterial conjunctivitis are self limiting; where treatment is appropriate, antibacterial eye drops or an eye ointment are used. A poor response might indicate viral or allergic conjunctivitis. Corneal ulcer and keratitis require specialist treatment and may call for hospital admission for intensive therapy. Endophthalmitis is a medical emergency which also calls for specialist management and requires intravitreal administration of antimicrobials; concomitant systemic treatment is required in some cases. Surgical intervention, such as vitrectomy, is sometimes indicated. Antibacterials for eye infections Bacterial eye infections are generally treated topically with eye drops and eye ointments. Systemic administration is sometimes appropriate in blepharitis. Chloramphenicol p. 1236 has a broad spectrum of activity and is the drug of choice for superﬁcial eye infections. Chloramphenicol eye drops are well tolerated and the recommendation that chloramphenicol eye drops should be avoided because of an increased risk of aplastic anaemia is not well founded. Other antibacterials with a broad spectrum of activity include the quinolones, ciproﬂoxacin p. 1235, levoﬂoxacin p. 1236, moxiﬂoxacin p. 1236, and oﬂoxacin p. 1236; the aminoglycosides, gentamicin below and tobramycin p. 1235 are also active against a wide variety of bacteria. Gentamicin, tobramycin, quinolones (except moxiﬂoxacin), and polymyxin B are effective for infections caused by Pseudomonas aeruginosa. Ciproﬂoxacin eye drops are licensed for corneal ulcers; intensive application (especially in the ﬁrst 2 days) is required throughout the day and night. Azithromycin eye drops p. 1235 are licensed for trachomatous conjunctivitis caused by Chlamydia trachomatis and for purulent bacterial conjunctivitis. Trachoma which results from chronic infection with Chlamydia trachomatis can be treated with azithromycin by mouth [unlicensed indication]. Fusidic acid is useful for staphylococcal infections. Propamidine isetionate p. 1237 is of little value in bacterial infections but is used by specialists to treat the rare, but potentially sight-threatening, condition of acanthamoeba keratitis [unlicensed indication]. Cefuroxime p. 1235 can be administered by intracameral injection for the prophylaxis of endophthalmitis following cataract surgery. With corticosteroids Many antibacterial preparations also incorporate a corticosteroid but such mixtures should not be used unless a patient is under close specialist supervision. In particular they should not be prescribed for undiagnosed ‘red eye’ which is sometimes caused by the herpes simplex virus and may be difﬁcult to diagnose. Administration Frequency of application depends on the severity of the infection and the potential for irreversible ocular damage; antibacterial eye preparations are usually administered as follows: . Eye drops, apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing. . Eye ointment, apply either at night (if eye drops used during the day) or 3–4 times daily (if eye ointment used alone). Antifungals for eye infections Fungal infections of the cornea are rare but can occur after agricultural injuries, especially in hot and humid climates. Orbital mycosis is rarer, and when it occurs it is usually because of direct spread of infection from the paranasal sinuses. Increasing age, debility, or immunosuppression can encourage fungal proliferation. The spread of infection through blood occasionally produces metastatic endophthalmitis. Many different fungi are capable of producing ocular infection; they can be identiﬁed by appropriate laboratory procedures. Antifungal preparations for the eye are not generally available. Treatment will normally be carried out at specialist centres, but requests for information about supplies of preparations not available commercially should be addressed to the Strategic Health Authority (or equivalent in Scotland or Northern Ireland), or to the nearest hospital ophthalmology unit, or to Moorﬁelds Eye Hospital, 162 City Road, London EC1V 2PD (tel. (020) 7253 3411) or www.moorfields.nhs.uk. Antivirals for eye infections Herpes simplex infections producing, for example, dendritic corneal ulcers can be treated with aciclovir p. 1237 or ganciclovir p. 1238. Aciclovir eye ointment is used in combination with systemic treatment for ophthalmic zoster. Slow-release ocular implants containing ganciclovir (available on a named-patient basis from specialist importing companies) may be inserted surgically to treat immediate sight-threatening CMV retinitis. Local treatments do not protect against systemic infection or infection in the other eye. See systemic treatment of CMV retinitis. 3.1 Bacterial eye infection ANTIBACTERIALS › AMINOGLYCOSIDES eiiii F 543

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Medicinal Forms

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Soybean oil

Overview

Indications And Dose

Dose and formulations

Medicinal Forms

Dose text by age group

Soybean oil

Overview

Indications And Dose

Dose and formulations

Medicinal Forms

Dose text by age group