Topical Eye Antibiotic

Aka: Topical Eye Antibiotic, Ophthalmic Antibiotic

1. Indications
   1. Treatment of infection
      1. Bacterial Conjunctivitis
   2. Prophylaxis in Eye Injury (avoid Aminoglycosides due to toxicity risk)
      1. Corneal Abrasion
      2. Chemical Eye Burn
2. Preparations: Most cost effective agents
   1. First-line
      1. Trimethoprim-Polymyxin B (Polytrim) solution
      2. Erythromycin 0.5% ointment
   2. Broad-spectrum
      1. Gentamicin (Gentak) 0.3% ointment or solution
      2. Tobramycin (Tobrex) 0.3% solution (ointment is not generic and is expensive)
      3. Ciprofloxacin (Ciloxan) 0.3% ointment or solution
      4. Ofloxacin (Ocuflox) 0.3% solution
3. Preparations: First-Line general purpose
   1. Trimethoprim-Polymyxin B (Polytrim) solution
   2. Sulfacetamide 10% (Bleph-10) ointment or Solution
      1. Typically avoid due to low efficacy and reaction risk
   3. Bacitracin ointment (used in stye)
4. Preparations: First-Line Macrolides (especially if Chlamydia suspected)
   1. Erythromycin 0.5% ointment
   2. Azithromycin 1% (Azasite) solution
5. Preparations: Broad-Spectrum Fluoroquinolones
   1. Precautions
      1. Reserve for severe infections to prevent resistance
   2. Besifloxacin (Besivance) 0.6% solution
   3. Ciprofloxacin (Ciloxan) 0.3% ointment or solution
   4. Gatifloxacin (Zymar) 0.3%
   5. Levofloxacin (Iquix) 1.5% or (Quixin) 0.5% solution
   6. Moxifloxacin (Vigamox) 0.5% solution
   7. Ofloxacin (Ocuflox) 0.3% solution
6. Preparations: Broad-spectrum Aminoglycosides
   1. Precautions
      1. Reserve for severe infections to prevent resistance
      2. Avoid if Corneal Injury (toxicity risk)
   2. Gentamicin (Gentak) 0.3% ointment or solution
   3. Tobramycin (Tobrex) 0.3% ointment or solution
7. Preparations: To Avoid
   1. Neomycin (topical reactions are common)
8. References
   1. Cronau (2010) Am Fam Physician 81(2): 137-45 [PubMed]