Antibiotic-steroid combination therapy

Antibiotic-Steroid Combinations for Topical Ocular Therapy... 

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... 

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. 

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. 

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. 

Bronchospasm is an early and prominent complication of chlorine exposure. Aggressive bron-chodilator therapy (a combination of adrenergic agent and theophylline) is appropriate. Steroids are used if the patient has a history of hyperreactive airways. Bronchodilators are used at least until the antibiotics are discontinued and there is no further evidence of clinical response (eg, as indicated by laboratory testing). Steroid doses should be tapered as rapidly as clinical circumstances warrant after the first 3 to 4 days of (uncomplicated) recovery. Superinfection may complicate prolonged steroid therapy. 

Studies conducted in our laboratories examined the effects of such conjoint therapy with antibiotics on eicosanoid levels and survival in septic shock. In the rat faecal peritonitis model, improved survival time was observed with early treatment with steroids. However, this protection appears to be independent of inhibition of arachidonic acid metabolism. Corticosteroid pretreatment effected no more than a 30 and 40% inhibition of plasma levels of iTxB2 and i6-keto-PGFi3( respectively, compared with 100% inhibition with the cyclo-oxygenase inhibitors. Conjoint steroid and NSAID treatment improved survival time compared with each drug employed individually. The combination of steroid, NSAID and gentamicin produced the most significant effect on survival. 

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