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

• sushmitagshahin@gmail.com