DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

Table 64–4
Topical Antibacterial Agents Commercially Available for Ophthalmic Use
GENERIC NAME (TRADE NAME) FORMULATION a TOXICITY INDICATIONS FOR USE
Azithromycin (AZASITE) 1% solution H Conjunctivitis
Bacitracin 500 units/g ointment H Conjunctivitis, blepharitis, keratitis,
keratoconjunctivitis, corneal ulcers,
blepharoconjunctivitis, meibomianitis, dacryocystitis
Besifloxacin (BESIVANCE) 0.6% suspension Conjunctivitis
Chloramphenicol 1% ointment H, BD Conjunctivitis, keratitis
Ciprofloxacin hydrochloride 0.3% solution; H, D-RCD Conjunctivitis, keratitis, keratoconjunctivitis,
(CILOXAN, others) 0.3% ointment corneal ulcers, blepharitis, blepharoconjunctivitis,
meibomianitis, dacryocystitis
Erythromycin 0.5% ointment H Superficial ocular infections involving the conjunctiva
(ILOTYCIN, others)
or cornea; prophylaxis of ophthalmia neonatorum
Gatifloxacin (ZYMAR) 0.3% solution H Conjunctivitis
Gentamicin sulfate 0.3% solution; H Conjunctivitis, blepharitis, keratitis,
(GARAMYCIN, GENOPTIC, 0.3% ointment keratoconjunctivitis, corneal ulcers,
GENT-AK, GENTACIDIN,
blepharoconjunctivitis, meibomianitis, dacryocystitis
others)
Levofloxacin (QUIXIN, IQUIX) 0.5% solution H Conjunctivitis
Levofloxacin (IQUIX) 1.5% solution H Corneal ulcers
Moxifloxacin (VIGAMOX) 0.5% solution H Conjunctivitis
Ofloxacin (OCUFLOX, others) 0.3% solution H Conjunctivitis, corneal ulcers
Sulfacetamide sodium 1%, 10%, 15%, and H, BD Conjunctivitis, other superficial ocular infections
(BLEPH-10, CETAMIDE, 30% solution;
ISOPTO CETAMIDE, others) 10% ointment
Polymyxin B combinations b Various solutions Conjunctivitis, blepharitis, keratitis
and ointments
Tobramycin sulfate c (TOBREX, 0.3% solution; H External infections of the eye and its adnexa
AKTOB, DEFY, others)
0.3% ointment
a
For specific information on dosing, formulation, and trade names, refer to the Physicians’ Desk Reference for Ophthalmic Medicines, which is
published annually. b Polymyxin B is formulated for delivery to the eye in combination with bacitracin, neomycin, gramicidin, oxytetracycline, or
trimethoprim. See Chapters 52-55 for further discussion of these antibacterial agents. c Tobramycin is formulated for delivery to the eye in combination
with dexamethasone or loteprednol etabonate. H, hypersensitivity; BD, blood dyscrasia; D-RCD, drug-related corneal deposits.
Staphylococcus aureus, Streptococcus spp.) or viral (most commonly
seen in mumps, infectious mononucleosis, influenza, and herpes
zoster). When bacterial infection is suspected, systemic
antibiotics usually are indicated.
Dacryocystitis is an infection of the lacrimal sac. In infants
and children, the disease usually is unilateral and secondary to an
obstruction of the nasolacrimal duct. In adults, dacryocystitis and
canalicular infections may be caused by S. aureus, Streptococcus
spp., diphtheroids, Candida spp., and Actinomyces israelii. Any discharge
from the lacrimal sac should be sent for smears and cultures.
Systemic antibiotics typically are indicated.
Infectious processes of the lids include hordeolum and blepharitis.
A hordeolum, or stye, is an infection of the meibomian, Zeis, or
Moll glands at the eyelid margins. The typical offending bacterium is
S. aureus, and the usual treatment consists of warm compresses and
topical antibiotic gel, drops, or ointment. Blepharitis is a common bilateral
inflammatory process of the eyelids characterized by irritation and
burning, and it also usually is associated with a Staphylococcus sp.
Local hygiene is the mainstay of therapy; topical antibiotics frequently
are used, usually in gel, drop, or ointment form, particularly when the
disease is accompanied by conjunctivitis and keratitis. Systemic tetracycline,
doxycycline, minocycline, and erythromycin often are effective
in reducing severe eyelid inflammation but must be used for weeks
to months.
Conjunctivitis is an inflammatory process of the
conjunctiva that varies in severity from mild hyperemia
to severe purulent discharge. The more common causes
of conjunctivitis include viruses, allergies, environmental
irritants, contact lenses, and chemicals. The less
common causes include other infectious pathogens,
immune-mediated reactions, associated systemic diseases,
and tumors of the conjunctiva or eyelid.