Trimethoprim-polymyxin

Many broad-spectrum topical antibiotics are approved to treat acute bacterial conjunctivitis (Table 60-2). Trimethoprim /polymyxin... 

Acute mucopurulent Gentamicin, tobramycin, trimethoprim/polymyxin B, ciprofloxacin, norfloxacin, ofloxacin, levofloxacin, gatifloxacin, or moxifloxacin Topical... 

Trimethoprim-polymyxin B is effective for the treatment of blepharitis, conjimctivitis, and blepharoconjunctivitis. Side effects are very rare. Because it is clinically effective against H. influenzae and Streptococcus pneumoniae, which are the most common causes of bacterial pediatric eye infections, it is a drug of choice for treating eye infections in children. 

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. 

If a significant inflammatory component or a response to bacterial exotoxin hypersensitivity in the fiarm of marginal corneal infiltrates or phlyctenules is present, treatment may require concurrent topical steroid therapy. When chronic dacryocystitis is involved, treatment should include irrigation of the lacrimal system with trimethoprim-polymyxin B or gentamicin. Adjunctive systemic antibiotic therapy may also be required (see Chapter 24). 

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... 

The conjvinctivitis associated with Reiter s syndrome is usually mild and transient.A topical aminoglycoside, erythromycin, or a combination agent such as trimethoprim-polymyxin B (Polytrim) may be used to treat more severe conjimctivitis. 

Wagner RS. Results of a survey of children with acute bacterial conjunctivitis treated with trimethoprim-polymyxin B ophthalmic solution. CfinTher 1995 17 875-881. 

Fblytrim Ophthalmic Solution—polymyxin B sulfate, trimethoprim sulfate... 

Polymyxin B is bactericidal fc>r most gram-negative organisms, especially Haemophilus and Pseudomonas species. Neisseria and Proteus species, however, are resistant. Combining polymyxin B with bacitracin or trimethoprim achieves broad-spectrum antibacterial activity for treating acute bacterial conjunctivitis. Because it is not absorbed through mucous membrane or skin tissue, polymyxin B is used primarily for superficial infections.Adverse reactions are rare. 

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... 

Saito M, Hoshi M, Igarashi A, Ogata H, Edo K. The marked inhibition of the bitter taste of polymyxin B sulfate and trimethoprim x sulfamethoxazole by flavored BMI-60 in pediatric patients. Biol Pharm Bull 1999 22(9) 997-8. 

An aminoglycoside ciprofloxacin trimethoprim-sulfamethoxazole ticarcillin, mezlocillin, or piperacillin ceftazidime minocycline doxycycline sulbactam polymyxin Gentamicin or tobramycin imipenem a fluoroquinolone Doxycycline azithromycin... 

Polytrim ophthalmic solution 1 mg/mL trimethoprim sulfate and 10,000 units/g polymyxin B sulfate)... 

Trimethoprim sulfate/polymyxin B sulfate is an antibiotic combination. Trimethoprim blocks production of tetrahy-drofoUc acid by inhibiting the enzyme dihydrofolate reductase. Polymyxin B interacts with phospholipid components of bacterial cell membranes, increasing cell-wall permeability. They are indicated in the treatment of surface ocular bacterial infections, including acute bacterial conjunctivitis and blepharoconjunctivitis caused by susceptible organisms. 

Orally administered trimethoprim is used in the treatment of chronic recurring urinary tract infection. Oral forms of trimethoprim-sulfamethoxazole are used in Shigella and some Salmonella infections, particularly when they are resistant to ampicillin and chloramphenicol. High doses of oral trimethoprim-sulfamethoxazole are used in Pneumocystis pneumonia. This combination, along with polymyxin, has been shown to be effective in treating sepsis caused by Serratia or Pseudomonas organisms. 

Polymyxin B sulfate, Aerosporin. Solubilities Weiss et al.. Antibiot. Chemother. 7, 374 (1957). Mixture with trimethoprim, Polytrim. 

Combinations of local and systemic antibiotics for selective decontamination of the digestive tract (SDD) have been advocated to reduce or prevent HAP and other nosocomial infections (108-114). The SDD often uses combinations of nonabsorbable antibiotics, such as aminoglycoside, polymyxin B, and amphotericin B in a paste, which is applied to the oropharynx, and a liquid, which is given orally, with and without systemic cefotaxime, trimethoprim, or... 

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