Antibiotic-steroid combination

Antibiotic-Steroid Combinations for Topical Ocular Therapy... 

When blepharitis and meibomianitis are present, treatment includes maintenance of good lid hygiene and use of topical antibiotics or antibiotic-steroid combinations. In some cases systemic antibiotics such as tetracycline may be necessary. 

Various types of preparations are used for the treatment of otic (ear) disorders. Otic preparations can be divided into three categories (1) antibiotics (2) antibiotic and steroid combinations and (3) miscellaneous preparations. The miscellaneous preparations usually contain one or more of the following ingredients ... 

Antibiotics can be administered either systemic or topical as monotherapy or part of a corticoid-steroid combination. Antibacterial therapy leads not only to reduction of bacterial colonization, but also in many cases to improvement of AE, even when not actively infected 83,84... 

Conservative treatment of zoster-associated conjunctivitis, including cold compresses, lubricants, and decongestants, carries the lowest risk of treatment-related complications. Treatment of the acute conjunctivitis with topical broad-spectrum antibiotics may help to prevent secondary bacterial infection. Increased patient comfort by reduction of conjunctival inflammation may be affected by the use of topical steroids. Often, a combination antibiotic-steroid is used to accomplish both of these goals. In contrast to herpes simplex infection in which steroids are specifically contraindicated, topical steroids do not exacerbate herpes zoster infection. If steroids are used, the patient should be carefully monitored for intraocular pressure elevation. 

Pregnant and lactating women and children younger than 8 years should avoid oral doxycycline therapy. In these patients erythromycin base, 500 mg four times daily for 7 days, or amoxicillin, 500 mg three times daily for 7 days, is an alternative to doxycycline. Once systemic therapy has been initiated, topical treatment with lubricants, rasoconstrictors, or a combination antibiotic-steroid may help to relieve the patient s ocular symptoms. 

Although topical antibiotics are used frequently in the management of ocular rosacea, no firm evidence demonstrates their efficacy as a sole therapeutic agent. Topical steroids, however, are effective for treating the inflammatory aspects and frequently are used four times daily in conjimction with antibiotics in combination products such asTobraDex (tobramycin-dexamethasone), Pred-G (gentamicin-prednisone), or Maxitrol (neomycin-polymyxin B-dexamethasone). Because of potential steroid-induced side effects, chronic use of these agents should be avoided. 

TLC has also been used to quantify steroids inoduced by biotransformation of sitostool (71), for the analysis of steroid-antibiotic drug combinations (55) and for stability testing (72). 

The on-line combination of TLC and MS via FAB, liquid SIMS, or MALDI has also been frequently described. The TLC-MS combination, recently reviewed by Somsen and co-workers, is applied for a wide variety of compounds, including drugs and their metabolites, antibiotics, steroids, alkaloids, lipids, bile acids, porphyrins, dyes and peptides. 

Classical or conventional pharmaceutical agents in combination with lactide/glycolide polymers have been widely studied since about 1973. In general, these compounds are bioactive agents usually produced by synthetic chemistry, with molecular weights of less than a few hundred and relatively stable structures. Examples include steroid hormones, antibiotics, narcotic antagonists, anticancer agents, and anesthetics. 

The current induction therapy for acute myelogenous leukemia (AML) usually consists of a combination of cytara-bine and daunorubicin, with the frequent addition of a steroid and/or an antimetabolite such as 6-thioguanine. The risk of infection is so high during this period that patients receive antibiotic and fungal prophylaxis. 

Blepharitis is a topical inflammation of the eyelid margins that should be treated using topical antibacterial agents. Gentamicin eye ointment is preferred to the fusidic acid drops since the ointment is a better formulation to be used where the condition involves the eyelid margins. Chloramphenicol eye drops is the third option since it is an antibiotic with a wider spectrum of activity. A combination of corticosteroid and antibiotic is not recommended because of the side-effects associated with the steroid. The use of oral tablets is not usually recommended since blepharitis can easily be managed with topical drops. The use of dexamethasone eye drops, monotherapy steroid, could clear the inflammation but mask persistence of infection. 

UGT activity is modulated by various hormones. Excess thyroid hormone and ethinyl oestradiol (but not other oral contraceptives) inhibit bilirubin glucuronidation. In contrast, the combination of progestational and oestrogenic steroids results in increased enzyme activity. Bihrubin glucuronidation can also be inhibited by certain antibiotics (e.g. novobiocin or gentamicin, at serum concentrations exceeding therapeutic levels) and by chronic hepatitis, advanced cirrhosis and Wilson s disease. 

Ocular polymyxin B is commercially available in combination with other antibiotics (see Table 11-6) or with steroids (seeTable 11-7) to treat infections of the lids and conjunctiva. It is also used to prevent infection when the conjunctiva or cornea is compromised or when a steroid is used. 

The most common form of neomycin administration is topical. The dmg is available in combination with other antibiotics and steroids in numerous ophthalmic, otic, and dermatologic preparations designed to treat a rariety of skin and mucous membrane infections (seeTables 11-6 and 11-7). Topical ocular application of neomycin can result in... 

Associated toxic epithelial keratitis should respond to blepharitis treatment. Topical steroids are generally not required imless the cornea is significantly involved or a phlyctenule is present. In this case prednisolone 0.12% used two or three times a day for a few days may be used. Combination steroid-antibiotic ointments, such as tobramycin-dexamethasone or the topical combination drop tobramycin-loteprednol, may prove to be useful for those patients complaining of excessive itching and burning. Steroids control the hypersensitivity component that is often present and reduce the congestion and irritation that often provoke the patient to rub the eye and aggravate the blepharitis. 

When patients are suspected of having underlying staphylococcal disease, both inflammatory and bacterial components can be managed with a steroid-antibiotic combination. Initial doses should be administered every 2 to 4 hours, depending on severity, for the first 24 to 48 hours. In most instances, patients obtain dramatic relief from symptoms and can diminish use of the drug in 7 to 10 days. Because of the association of Staphylococcus with eyelid disease, lid therapy should be instituted. Antibiotic ointments such as erythromycin, bacitracin,... 

The typical postoperative anti-inflammatory regimen includes the use of a topical steroid separate from or in combination with an antibiotic. Patients who experience an abnormal elevation in lOP due to steroid therapy may experience a delayed or diminished pressure rise with 0.1% fluorometholone acetate, 1% rimexolone, or 0.5% loteprednol versus other agents and still have the desired anti-inflammatory effect. 

Some preparations fit into more than one of these categories. For example, the base of many creams acts as an emollient while the active medication is a steroid or antibiotic. There are also preparations that combine antibiotics and steroids in one formulation. 

The link between SEs and allergic disorders is most firmly established for atopic dermatitis (AD) (reviewed in Leung [10] and Breuer et al. [11]). AD affects 10-15% of the population, but S. aureus colonization is observed in the skin lesions of >90% of AD patients, compared with 5% of normal skin [12], Moreover, the intensity of skin inflammation has been correlated with the degree of S. aureus colonization [13]. Most strains of S. aureus grown from atopic skin have been shown to produce SEs with superantigenic properties [14], In accordance with the view that the SEs induce or exacerbate AD, treatment of AD patients with steroids in combination with antibiotics is more effective than treatment with steroids alone [15, 16]. 

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