Erythromycin ointment

Heat petrolatum and mineral oil in a steam kettle to 115°C and maintain temperature for at least 3 hours. 

Mix erythromycin with 78 g of base and stir until thoroughly dispersed. 

Run through 200 mesh (74-prn aperture) screen on Homoloid mill directly into main portion of petrolatum-oil mixture. 

Rinse mill with reserved petrolatum-oil mixture from step 3. 

Mix 2 hours before cooling. Cool slowly to avoid condensation. 

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Erythromycin Ointment 0.5% Erythromycin (Various) Ilotycin (Dista) Romycin (OCuSoft)... 

Staphylococcal infections of the eyelid are commonly treated with erythromycin ointment applied to the Ud margins (see Table 11-1). Warm moist compresses should be applied to the lid, and then the lid margins should be gently cleaned with diluted baby shampoo or a commercial lid cleanser before applying the drug. Erythromycin ointment can be applied only at bedtime or more often as required by infection severity. For the prophylaxis of ophthalmia neonatorum, a 0.5- to 1-cm ribbon of erythromycin ointment is instilled into each conjunctival sac and not flushed from the eyes after application. 

Anaphylactic shock due to macrolides is an extremely rare event (Grater 1962). There have been reports of urticaria (Prasad 1960 Ketel 1976) and one report on a fixed drug eruption following erythromycin therapy (Naik 1976). The safety of topical erythromycin treatment has been investigated in 60 patients with stasis ulcers. None of these patients showed any local irritation or contact dermatitis and this type of treatment was therefore recommended (Fisher 1976 a, b). Ketel (1976), however, observed allergic contact dermatitis in one woman after topical treatment with 5% erythromycin ointment and stated that this form of therapy was not without risk, albeit small. Allergic contact dermatitis due to tylosin and spiramycin has been observed in farmers (Preyss 1969 Velen et al. 1980). 

Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The CDC recommends that either tetracycline (1%) ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum. 

Infants born to mothers with gonococcal Erythromycin (0.5%) ophthalmic ointment in a single application0 or infection (prophylaxis) Tetracycline (l%) ophthalmic ointment in a single application0... 

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. 

B, erythromycin, gentamycin sulfate, neomycin sulfate, and tetracycline hydrochloride ointments may contain up to 1% moisture [15]. 

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. 

Alternatively, antibiotics such as trimethoprim-polymyxin B (Polytrim), gentamicin, or tobramycin solution, instilled as one drop four times daily for 5 to 7 days, or prior generation fluoroquinolones such as ciprofloxacin, ofloxacin, or levofloxacin, dosed four times daily for 5 to 7 days, may be prescribed. Bacitracin-polymyxin B (Polysporin), erythromycin, gentamicin, tobramycin, or ciprofloxacin ointment may be used at bedtime as supplemental therapy or four times daily in children or other patients who are not comfortable with eyedrops. 

Antibiotic therapy should be limited to periods of disease exacerbation, with the eyelid hygiene providing the daily maintenance regimen. Occasionally, topical erythromycin, bacitracin, or bacitracin-polymyxin B ointment applied at bedtime for several weeks proves beneficial as part of the therapeutic protocol. This type of chronic therapy, however, always carries the risk of fitster-ing overgrowth of resistant organisms. 

Initial treatment of bacterial ophthalmia neonatorum should be directed by the results of conjimctival smears. Broad-spectrum antibiotics with low toxicity should be used. Topical erythromycin or tetracycline ointment can be used four to six times daily fc>r gram-positive organisms, and gentamicin or tobramycin solution four to six times daily can be started if gram-negative organisms are isolated. Trimethoprim-polymyxin B (Polytrim) has... 

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,... 

Although phlyctenules can resolve spontaneously, they usually ulcerate and scar before resolution. To prevent scarring, treatment should include 1% prednisolone acetate, one drop every 2 to 4 hours for 3 to 4 days. Also, instill prophylactic antibiotic ointment or drops, such as bacitracin, erythromycin, or polymyxin B/trimethoprim, into the conjunctival sac four times a day and continue as... 

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. 

The clinical significance and incidence of chemical conjunctivitis due to silver nitrate has been investigated in 1000 newborn infants (27). Rinsing after instillation does not reduce the conjunctival irritation. Although 90% of the infants had conjunctivitis in the first 6 hours of life, in most cases it cleared within 24 hours. Chemical conjunctivitis did not increase the incidence of secondary infections. In 1980 the American Academy of Pediatrics pointed out the need for continued prophylaxis for all newborn infants, and proposed a 1% silver nitrate solution in single dose ampules or single-use tubes of an ophthalmic ointment with 1% tetracycline or 0.5% erythromycin. However, in infants of mothers with clinically apparent gonorrhea aqueous crystalhne penicillin G should be injected. 

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