Steroid/antibiotic combinations

Question 1

How do you know when to use a steroid/antibiotic combo?

Answer 1

Is there any need for antibiotic, or would steroid mono therapy be more appropriate? - Antibiotic is indicated where there is obvious mucopurulent discharge (active infection). If no evidence of active infection exists, there is no need for antibiotic.

Is condition primarily infectious with secondary inflammation, or primarily inflammatory with need for prophlyaxis? - Must look at the corneal epithelium. SPK or PEE do NOT require antibiotic protection from opportunistic infections. Only use combo when significant epithelial compromise is seen. Most significant bacterial infections cause secondary significant inflammation and require a combination (kill bacteria while suppressing secondary inflammation for rapid tissue normalization)

Is the condition acute or chronic? - (ex. bacterial conjunctivitis vs. rosacea blepharitis). Chronic conditions require protracted use of medication

Question 2

What are the corticosteroids used in topical combination medications?

Answer 2

Prednisolone

Hydrocortisone

Dexamethasone

Loteprednol

Question 3

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

Answer 3

Combination of Prednisolone acetate and sodium sulfacetamide in topical or ung

Blepharitis (rarely used)

2 gtt in eye(s) q4h while awake]

Alt: 0.5 inch ribbon oint in eye(s) to conjunctival sac tid-qid and qhs; Info: for ocular inflammation w/ superficial bacterial infection or risk; taper dose gradually to D/C if long-term use

Question 4

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

Answer 4

Combination of neomycin/polymyxin B (broad spectrum including pseudomonas species) and dexamethasone in ung and topical form - USED MOST FREQUENTLY because it is effective and inexpensive!

[ointment]
Dose: apply in eye(s) tid-qid; Info: for ocular inflammation w/ superficial bacterial infection or risk; taper dose gradually to D/C if long-term use

[suspension]
Dose: 1-2 gtt in eye(s) q4-6h; Info: for ocular inflammation w/ superficial bacterial infection or risk; taper dose gradually to D/C if long-term use; for severe dz, may start 1-2 gtt in eye(s) q1h x1-2 days, then taper dose gradually to D/C

Question 5

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

Answer 5

Combination dexamethasone and tobramycin

Broad spectrum coverage with good steroid

Dexamethasone can cause IOP spike and shouldn’t be used more than 2 weeks

[ointment]
Dose: apply 0.5 inch oint to conjunctival sac tid-qid; Info: for ocular inflammation w/ superficial bacterial infection or risk; taper dose gradually to D/C if long-term use

[suspension]
Dose: 1-2 gtt in eye(s) q4-6h; Info: for ocular inflammation w/ superficial bacterial infection or risk; taper dose gradually to D/C if long-term use; for severe dz, may start 1-2 gtt q2h x1-2 days, then taper dose gradually to D/C

Question 6

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

Answer 6

Combination of loteprednol and tobramycin

bacterial infections with secondary inflammation - USE INSTEAD OF MAXITROL WHEN THERAPEUTIC INTERVENTION IS NEEDED BEYOND 2 WEEKS

Does NOT cause increased IOP like other combination drops (ex. tobradex)

[1-2 gtt in eye(s) q4-6h]
Info: for superficial bacterial infection or risk; may start 1-2 gtt in eye(s) q1-2h x24-48h; taper dose frequency gradually to D/C

Question 7

What do you expect when you see round or oval shaped processes at or near the limbus? How should you treat?

Answer 7

Inflammatory event! (herpetic infection presents here, but it is linear, not round)

Use a combination drop!

Question 8

In any acute, unilateral red eye with serous discharge, what should be on your differential?

Answer 8

must r/o herpetic corneal lesions and suspect and rule out adenoviral infection (look for palpable lymphadenopathy on involved side)