Antibiotics ophthalmic ointment

Neomycin 0.35% Triple Antibiotic Ophthalmic Ointment (Various)... 

The client diagnosed with bilateral conjunctivitis is prescribed antibiotic ophthalmic ointment. Which interventions should the nurse implement when discussing the medication with the client Select all that apply. 

Oils have been used as vehicles for several topical eyedrop products that are extremely sensitive to moisture. Tetracycline HC1 is an antibiotic that is stable for only a few days in aqueous solution. It is supplied as a 1% sterile suspension with Plastibase 50W and light liquid petrolatum. White petrolatum and its combination with liquid petrolatum to obtain a proper consistency is routinely used as the vehicle for ophthalmic ointments. 

For prophylaxis of ophthalmia neonatorum, various groups have proposed the use of erythromycin (0.5%) or tetracycline (1%) ophthalmic ointment in lieu of silver nitrate. Although silver nitrate and antibiotic ointments are effective against gonococcal ophthalmia neonatorum, silver nitrate is not effective for chlamydial disease and may cause a chemical conjunctivitis. 

Ointments are commonly used for topical application of drugs to the eye.These vehicles are primarily mixtures of white petrolatum and liquid mineral oil with or without a water-miscible agent, such as lanolin.The mineral oil is added to the petrolatum to allow the vehicle to melt at body temperature, and the lanolin is added to the nonemulsive ointment base to absorb water. This allows for water and water-soluble drugs to be retained in the delivery system. Commercial ophthalmic ointments are derivatives of a hydrocarbon mixture of 60% petrolatum USP and 40% mineral oil USP, forming a molecular complex that is semisolid but melts at body temperature. In general, ointments are well tolerated by the ocular tissues, and when antibiotics are incorporated they are usually more stable in ointment than in solution. 

A fixed-combination ointment containing oxytetracy-cline and polymyxin B is available for topical ocular use (see Table 11-6). The Centers for Disease Control and Prevention recommends ophthalmic ointments containing a tetracycline or erythromycin as an effective alternative to silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum. A major advantage of using an antibiotic ointment such as oxytetracycline-polymyxin B is that it does not canse the chemical conjunctivitis typically produced by silver nitrate. 

Broad-spectrum antibiotic drops, such as 0.3% tobramycin, 0.3% ciprofloxacin, or the newer generation fluoroquinolones, moxifloxacin or gatifloxacin, may be instilled four times daily to prevent secondary infection as the epithelium heals. A broad-spectrum ophthalmic ointment, such as 0.3% ciprofloxacin, may be instilled into the conjunctival sac at bedtime for prophylaxis. In more pronounced cases, pupillary dilation and cyclo-plegia with a long-acting agent such as 5% homatropine may help to relieve pain from associated ciliary spasm. 

Since October 1973, FDA regulations require that all U.S. ophthalmic ointments be sterile. This legal requirement was a result of several surveys on microbial contamination of ophthalmic ointments, and followed reports in Sweden and the United Kingdom of severe eye infections resulting from use of nonsterile ointments. In its survey published in 1973, the FDA found that of 82 batches of ophthalmic ointments tested from 27 manufacturers, 16 batches were contaminated, including 8 antibiotic-containing ointments. The contamination levels were low and were principally molds and yeasts... 

Tin is the least reactive of the metals available, is very bright and is also non-toxic. However, it is inherently expensive and its usage is therefore restricted to pharmaceuticals such as antibiotic and some ophthalmic ointments where maximum protection is required. Lead-based tubes are now not recommended for pharmaceutical products, for toxicity reasons. 

The eye should be cleaned with warm water prior to applying antibiotic ointment. There is no antibiotic solution used prior to using ophthalmic ointment. 

Bacitracin given parenteraHy is sufftciendy nephrotoxic that it is rarely used in human medicine for other than topical indications (80). Thus safe and effective use, especially as the zinc salt, is limited almost completely to ointments, sprays, and solutions for skin and ophthalmic use in concentrations of 250 to 1000 units per milliliter. Bacitracin is only rarely skin sensitizing. As in the case of polymyxin, bacitracin is usually combined with other antibiotics to enlarge its spectmm of activity, or with corticoids or analgesics to reUeve pain or itching. 

Inorganic silver salts are strongly bactericidal. Silver nitrate, 1 1000, has been most commonly used, particularly as a preventive for gonococcal ophthalmitis in newborns. Antibiotic ointments have replaced silver nitrate for this indication. Silver sulfadiazine slowly releases silver and is used to suppress bacterial growth in burn wounds (see Chapter 46 Sulfonamides, Trimethoprim, Quinolones). 

Descemet s membrane, reestablishing stromal deturges-cence. Conservative therapeutic measures may be instituted during this resolution period, including the use of topical 5% sodium chloride drops during the day and 5% sodium chloride ointment instilled into the conjunctival sac at bedtime. Broad-spectrum topical ophthalmic antibiotics may be instituted to protect the compromised cornea from secondary bacterial infection. 

Small corneal abrasions typically heal quickly (24 to 36 hours). Topical prophylactic antibiotic therapy protects the disrnpted corneal epithelium from secondary infection as the tissne heals. Broad-spectrum ophthalmic antibiotic drops, snch as 0.3% tobramycin or 0.5% moxi-floxacin, may be instilled four times daily, along with a broad-spectrnm antibiotic ointment such as 0.3% tobramycin or 0.3% ciprofloxacin instilled at bedtime. Prophylactic topical antibiotic therapy can be discontin-ned once the corneal epithelium has healed. 

Ciprofloxacin, which is available in an aqueous 0.3% ophthalmic solution and an ointment farm, has a broad spectrum of action. Ciprofloxacin has been shown to be at least as successful in treating corneal ulceration as fortified antibiotics however, as mentioned earlier, there appears to be an increasing number of resistant strains since its introduction. The usual dosage of ciprofloxacin solution for the treatment of bacterial ulcers is two drops every 15 minutes for 6 hours, then two drops every 30 minutes for 18 hours, followed by two drops every hour for 24 hours. Ciprofloxacin is then used every 4 hours for the next 12 days. Ciprofloxacin ointment also is effective in the treatment of bacterial keratitis. It is applied every 1 to 2 hours in the first 2 days and then every 4 hours for the next 12 days. 

Topical corticosteroids are used in cases of exacerbation and should be applied sparingly to the affected area. Hydrocortisone 1% twice a day or dexamethasone 0.1% applied to the periorbital area helps to relieve symptoms during these periods. Secondary infection manifested as blepharitis or keratoconjimctivitis should be treated with topical ophthalmic antibiotic ointments such as bacitracin or erythromycin.Topical antihistamines, NSAIDs, or mast cell stabilizers can be used to control itching, and topical steroids are sometimes required to treat severe keratoconjunctivitis associated with the atopic response. Because of side effects, steroids are not indicated for longterm use. 

Bacitracin is available in ophthalmic and dermatologic ointments the antibiotic also is available as a powder for the preparation of topical solutions. The ointments are applied directly to the involved surface one or more times daily. A number of topical preparations of bacitracin, to which neomycin or polymyxin or both have been added, are available, and some contain the three antibiotics plus hydrocortisone. For open infections such as infected eczema and infected dermal ulcers, the local application of the antibiotic may be of some help in eradicating sensitive bacteria. Bacitracin rarely produces hypersensitivity. Suppurative conjunctivitis and infected comeal ulcer respond well to the topical use of bacitracin when caused by susceptible bacteria. Bacitracin has been used with limited success for eradication of nasal carriage of staphylococci. Oral bacitracin has been used with some success for the treatment of antibiotic-associated diarrhea caused by C. difficile. Serious nephrotoxicity results from the parenteral use of bacitracin. Hypersensitivity reactions rarely result from topical application. 

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