Upload
edmund-mitchell
View
259
Download
4
Embed Size (px)
Citation preview
Preparation of fortified eye drops
Dr Sushmita G ShahDNB(Sankara Nethralaya), FICO, FLVPEI
Fellow Cornea – Mass. Eye & Ear Infirmary, Boston, USA
Consultant Cornea & Anterior Segment Surgeon
Eye Life Eye Hospital, Khar(W), Mumbai Netra Mandir, Mumbai
No financial interests
Purpose• Fortification – dictionary meaning• the act, art, or science of fortifying or
strengthening• Fortification of antibiotics may be required 1. To achieve the MIC levels for pathogens which
may be difficult with the usual 0.3% / usual strength topical antibiotics
2. Drug resistant cases3. In large and severe ulcers4. Drug is available in parenteral form and not as
topical drops
Drawbacks of fortification
Gokhale NS. Ind J Ophthalmol
General instructions• Should be done by doctor or pharmacist inside a
laminar air hood under aseptic precautions conditions
• Disposable syringe should be used• All drops should be labelled • Date of preparation and date of expiry should be
mentioned• Prescription describing frequency of application
etc should also be given to the patient• Storage instructions should also be given
Fortified Aminoglycosides
Fortified Rx
ADD Final Concentration
Storage
Shelf life
Tobramycin(1.4%)
Tobramycin 0.3% eye drop- 15mg in 5 ml
Inj. Tobramycin-2ml/80mg
Tobramycin95 mg in 7 ml – 1.4%
4deg C 1 week in Fridge4 days in room temperature
Gentamycin(1.4%)
Gentamicin 0.3%eye drop- 15mg in 5 ml
Inj. Gentamicin-2ml/80mg
Gentamicin95 mg in 7 ml - 1.4%
4deg C 1 week in Fridge4 days in room temperature
Fortified Aminoglycosides
Fortified Rx
Add Final concentration
Temperature
Stability
Amikacin 2.5%
Inj Amikacin250mg/2ml
8ml artificial tears
Amikacin250mg/10ml –2.5%
4deg C 7 days
Drug ADD
Fortified Cefazolin 5%
Inj. Cefazolin – 5oomg
10 ML artificial tears
500mg in 10 ml – 5%Fortified Cefazolin
4 deg C 1 week
Fortified Ceftazidime 5%
Inj Ceftazidime 500mg
10 ML artificial tears
500mg in 10 ml – 5%Fortified Ceftazidime
4 deg C 1 week
Fortified Cephalosporins
Topical Linezolid 0.2%• Lancure / Adlid /Rapidline IV infusion • 200mg/100ml
• Topical ophthalmic dosage – 0.2%(2mg/ml)• Indications – • Methicillin resistant Staphylococcus aureus
keratitis• Corneal surface toxicity less than topical
Vancomycin
Tas T. Cornea 2013
Topical Vancomycin 5%
• Available as Inj Vancomycin HCL – 500mg• Add 2ml sterile water for reconstitution • Add 8ml artificial tears• 50mg/ml – 5% Vancomycin• Stabilty – 28 days at 4deg C
• Methicillin resistant Staphylococcus aureus keratitis
• Corneal surface toxicity – greatest drawback
Topical colistin 0.19%• Inj Xylistin – Colistimethate sodium powder• 1million IU/75mg• Added to 10ml distilled water – 75mg/ml(0.75%)• 1ml of above solution + 3ml distilled water – 0.19% Colistin drops
• For pandrug/multidrug resistant Pseudomonas aeruginosa keratitis
Topical Imipenem-cilastin 1%
• Inj. Imipenem(500mg) + Inj Cilastin (500mg)• Add 10ml sterile water – 50mg/ml• Take 1 ml of this solution and add 4 ml sterile
water• Topical Imipenem 1% - 1mg/ml• Store in amber coloured bottles• Stability – 3 days at 2-8 deg C
Topical Voriconazole 1%
• 200mg of Voriconazole powder• Add 19ml normal saline• Voriconazole 1% eye drop• Stable – 30days at 4deg C or room temperature• Intracameral voriconazole inj. - 10µgm/ml to
10mg/ml concentration of Voriconazole has been described.
• Also available from Aurolab
Intrastromal Voriconazole
• 50 µgm/0.1ml • From1% solution, take 0.5ml, add 0.5ml sterile
water• 5mg/ml – take 0.1ml,add 0.9ml – 0.5mg/ml• 0.5mg/ml – take 0.1ml, add 0.9ml – 0.05mg/ml• 50 µgm/0.1ml
Topical Amphotericin B 0.15%
• 50mg Amphotericin B powder• Add 10ml sterile water – 5mg/ml• Take 3ml of this solution and add 7ml artificial
tears – 1.5mg/ml = 0.15%• Storage – 7 days at 4deg C
Intracameral Amphotericin
• 5 -10 µgm/0.1ml injected • Reconstituition in 5% Dextrose or sterile water• From 5mg/ml solution – take 0.1ml solution• Add 0.9ml 5%Dextrose / sterile water• Again take 0.1ml and add 0.9ml
5%Dextrose/Sterile water• 5 µgm/0.1ml• Same concentration is used for intrastromal
injection
• Thank you