Preparation of fortified eye drops Dr Sushmita G

Preparation of fortified eye drops Dr Sushmita G Shah DNB(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 cases 3. In large and severe ulcers 4. 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 Storage Concentrati on Shelf life Tobramycin Inj. Tobramycin 4 deg C (1. 4%) 0. 3% eye Tobramycin 95 mg in 7 drop -2 ml/80 mg ml – 1. 4% - 15 mg in 5 ml 1 week in Fridge 4 days in room temperature Gentamycin Gentamicin (1. 4%) 0. 3% eye drop - 15 mg in 5 ml 1 week in Fridge 4 days in room temperature Inj. Gentamicin- 95 mg in 7 2 ml/80 mg ml - 1. 4% 4 deg C

Fortified Aminoglycosides Fortified Rx Amikacin 2. 5% Add Inj Amikacin 8 ml 250 mg/2 ml artificial tears Final concentration Tempera ture Stability Amikacin 250 mg/10 ml – 2. 5% 4 deg C 7 days

Fortified Cephalosporins Drug Fortified Cefazolin 5% ADD Inj. Cefazolin – 5 oomg 10 ML artificial tears 500 mg in 10 ml – 5% Fortified Cefazolin 4 deg C 1 week Fortified Inj 10 ML Ceftazidime artificial 5% 500 mg tears 500 mg in 10 ml – 5% Fortified Ceftazidime 4 deg C 1 week

Topical Linezolid 0. 2% • Lancure / Adlid /Rapidline IV infusion • 200 mg/100 ml • • Topical ophthalmic dosage – 0. 2%(2 mg/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 – 500 mg Add 2 ml sterile water for reconstitution Add 8 ml artificial tears 50 mg/ml – 5% Vancomycin Stabilty – 28 days at 4 deg C • Methicillin resistant Staphylococcus aureus keratitis • Corneal surface toxicity – greatest drawback

Topical colistin 0. 19% • • Inj Xylistin – Colistimethate sodium powder 1 million IU/75 mg Added to 10 ml distilled water – 75 mg/ml(0. 75%) 1 ml of above solution + 3 ml distilled water – 0. 19% Colistin drops • For pandrug/multidrug resistant Pseudomonas aeruginosa keratitis

Topical Imipenem-cilastin 1% • • • Inj. Imipenem(500 mg) + Inj Cilastin (500 mg) Add 10 ml sterile water – 50 mg/ml Take 1 ml of this solution and add 4 ml sterile water Topical Imipenem 1% - 1 mg/ml Store in amber coloured bottles Stability – 3 days at 2 -8 deg C

Topical Voriconazole 1% • • • 200 mg of Voriconazole powder Add 19 ml normal saline Voriconazole 1% eye drop Stable – 30 days at 4 deg C or room temperature Intracameral voriconazole inj. - 10µgm/ml to 10 mg/ml concentration of Voriconazole has been described. • Also available from Aurolab

Intrastromal Voriconazole • • • 50 µgm/0. 1 ml From 1% solution, take 0. 5 ml, add 0. 5 ml sterile water 5 mg/ml – take 0. 1 ml, add 0. 9 ml – 0. 05 mg/ml 50 µgm/0. 1 ml

Topical Amphotericin B 0. 15% • 50 mg Amphotericin B powder • Add 10 ml sterile water – 5 mg/ml • Take 3 ml of this solution and add 7 ml artificial tears – 1. 5 mg/ml = 0. 15% • Storage – 7 days at 4 deg C

Intracameral Amphotericin • • • 5 -10 µgm/0. 1 ml injected Reconstituition in 5% Dextrose or sterile water From 5 mg/ml solution – take 0. 1 ml solution Add 0. 9 ml 5%Dextrose / sterile water Again take 0. 1 ml and add 0. 9 ml 5%Dextrose/Sterile water • 5 µgm/0. 1 ml • Same concentration is used for intrastromal injection

• Thank you • sushmitagshahin@gmail. com