Antibiotics

Question 0

What is oral azithromycin used to treat? Brand names? Dose?

Answer 0

Adult inclusion chlamydial conjunctivitis

Generic and Zithromax

Single dose of 1000mg

Question 1

What is AzaSite? Approved to treat? Dosing schedule?

Answer 1

Azithromycin 1%

Bacterial conjunctivitis

BID x 2 days; QD x 5 days

Question 2

What is bacitracin? Used to treat? Dose?

Answer 2

Gram positive bactericidal ointment

Blepharitis (staph origin) and augmentation to topical treatment of bacterial conjunctivitis/keratitis

QHS for induced blur

Question 3

What is bacitracin/polymyxin B? Used to treat? Dose?

Answer 3

Gram positive and negative bactericidal ointment

Blepharitis (staph origin) and augmentation to topical treatment of bacterial conjunctivitis/keratitis

QHS for induced blur

Question 4

What is Cephalexin? Cautions? Used to treat? Dose? Other options?

Answer 4

1st generation oral cephalosporin (avoid use with penicillin allergies)

Go to oral drug for all moderate to advanced acute eyelid infections

500mg po BID x 1 week wit adjunct warm lid soaks

If allergic, use 2-3 generation, bactrim (sulfamethoxazole/trimethoprim), doxy, fluoroquinolone, macrolide

Question 5

What is besifloxacin? Used to treat? Dose?

Answer 5

Topical broad spectrum fluoroquinolone

Moderate to severe bacterial and corneal infections/ulcers

Severe: loading dose of q15min for 1 hour, then hourly while awake for 1-3 days; taper to q2h for 2-3 days; QID for 2-3 days. Always RTC every day!

Corneal abrasions/erosions, use QID coverage

Consider polysporin or neosporin ointment at bedtime

Question 6

What is Ciprofloxacin? Used to treat? Dose?

Answer 6

Early generation fluoroquinolone with near 4th gen efficacy

DOC for pseudomonas infection and general external eye bacterial infections

Severe: hourly while awake for 1-3 days; taper to q2h for 2-3 days; QID for 2-3 days

Question 7

What is Erythromycin? Used to treat? Dose?

Answer 7

Topical macrolide ung that is bacteriostatic

2nd line Tx for many things. Used mostly as overnight prophylaxis for corneal abrasion or exposure keratitis

QHS

Question 8

What is Doxycycline? Used to treat? Dose?

Answer 8

Tetracycline class that can be taken with meals

MRSA infections and other skin infections; can be used for chlamydial infection; MGD, dry eye, rosacea, RCE or inflamed pterygium

Meibomianitis: 50-100mg BID for 4-8 weeks then qd for 3-6mo
Acne rosacea: 100mg BID until resolution with taper to 100mg qd for several weeks

Chlamydia: 100mg BID x 10 days

RCE: 50mg BID x 2mo to help hemidesmosome formation

Question 9

What is oral erythromycin? Used to treat? Dose?

Answer 9

Non-highly used oral macrolide

Blepharoconjunctivitis in children 10)

250-500 mg po BID-QID depending on severity and weight of patient

Question 10

What is Gatifloxacin? Used to treat? Dose?

Answer 10

Topical 4th gen fluoroquinolone (zymaxid)

At risk for resistance d/t overuse! DOC for pseudomonas infection and general external eye bacterial infections

Severe: hourly while awake for 1-3 days; taper to q2h for 2-3 days; QID for 2-3 days

Question 12

What is tobramycin/gentamicin? Used to treat? Side effects? Dose?

Answer 12

Old generic topical aminoglycosides that are HIGHLY efficacious

Bacterial conjunctivitis

Not used systemically d/t ototoxicity; causes corneal toxicity: d/c use at this pony and employ AT and switch to TMP/polymyxin B or besivance

1gtt QID x 7-10 days

Question 13

What is levofloxacin? Used to treat? Side effects? Dose?

Answer 13

Third generation ORAL (topical is no longer used in the US) fluoroquinolone

Rather expensive and not used as a first choice for acute eye and eyelid infections (rather, use Keflex (cephalexin) 500mg bid x 1-week) UNLESS PT HAS PENICILLIN ALLERY, then this is a GREAT choice

1 tab qd x 7-10 days

Question 14

What is moxifloxacin? Used to treat? Side effects? Dose?

Answer 14

Fourth generation TOPICAL fluoroquinolone (Moxeza and Vigamox) that is becoming less effective against resistant bacteria. Moxeza has a longer contact time rom a gum base with reduced dosing frequency. Vigamox is preservative free = low toxicity to cornea

Bacterial conjunctivitis (but authors recommend vancomycin or tobramycin (fortified) for efficacy)

1 gtt in eye(s) tid x7 days

Question 15

What is ofloxacin? Used to treat? Side effects? Dose?

Answer 15

Minimally used second gen TOPICAL fluoroquinolone

Bacterial conjunctivitis (generic and inexpensive)

Question 16

What is trimethoprim? Used to treat? Side effects? Dose?

Answer 16

Typically found TOPICALLY in combination with other drugs d/t high gram + spectrum (ex. Polytrim - has good broad spectrum coverage). NOT A SULFA DRUG - inhibits folic acid metabolism; or ORALLY in combination with sulfamethoxazole (Bactrim)

Corneal abrasion with BCL topically; MRSA infections (like levofloxacin) when Pt is allergic to penicillin

[1 gtt in eye(s) q3h x7-10 days]
Max: 6 doses/day; 2 TAB bid x 7-10 days (double strength)

Question 17

T/F Neomycin allergies are of clinical significance and should be avoided at all costs

Answer 17

False - can rarely (10% of patients) cause type IV hypersensitivity to eye surface and eyelids and is NOT of serious concern

If you see this reaction clinically, stop the antibiotic and have pt use cool compress and use adjunct steroid to suppress inflammation

Again, this is more annoying than a crisis.

Question 18

What is Augmentin? Used to treat? Dose?

Answer 18

Amoxicillin + Clavulanic Acid

Used for bacterial infections of eyelid like hordeolum, preseptal cellulitis, etc.

500/875/1000mg tablets BID x 1week depending on infection severity

Question 19

What are cephalosporins used to treat? Dose?

Answer 19

Keflex used to treat dacryoadenitis, dacryocystitis and preseptal cellulitis - dose 250-500mg BID-QID

Ceftriaxone IM or IV for gonococcal conjunctivitis and orbital cellulitis - corneal involvement use 1g IV q12-24h and watch for clinical response, no cornea involvement, use 1g IM; orbital cellulitis IV with hospitalization for 1 week