Newer antibiotics

Besivance (besifloxacin ophthalmic suspension 0.6%, Bausch & Lomb),

• has a long-lasting vehicle, DuraSite, which facilitates prolonged exposure
• treats a wide spectrum of bacteria, particularly methicillin-resistant Staphylococcus aureus, with no apparent toxicity
• dosing is listed as 4 to 12 hours on the labeling, (e.g. presurgical prophylaxis TID, keratitis q2h then QID, depending on severity, and for a conjunctivitis BID or TID).”

Iquix (levofloxacin ophthalmic solution 1.5%, Vistakon Pharmaceuticals),

• approved for the treatment of susceptible gram-positive and gram-negative bacterial corneal ulcers (incl. Pseudomonas usually in CL infections)
• dosage and administration: for days 1 through 3, instill one to two drops in the affected eye q30minutes to 2 hours while awake and about 4 and 6 hours after retiring. For day 4 through treatment completion, instill one to two drops in the affected eye every 1 to 4 hours while awake.

AzaSite (topical azithromycin solution 1%, Inspire Pharmaceuticals)

• also formulated with DuraSite (prolonged exposure)
• is approved for bacterial conjunctivitis; however off-label use for blepharitis is showing positive results
• hot compresses, lid scrubs and omega-3 supplements are effective in maintaining blepharitis patients long-term after they stop initial therapy of topical azithromycin
• blepharitis is a chronic disease, and doctors should consider additional courses of topical azithromycin throughout a year to improve patients’ symptoms
• Restasis (0.05% cyclosporine ophthalmic emulsion, Allergan) may be a consideration long-term for the concurrent dry eye
• Azithromycin as a molecule has significant penetration and residence time in tissue
• for bacterial conjunctivitis, the recommended dosing of topical azithromycin is one drop BID for 2 days, and QD for five day
• for blepharitis, dosing is extended to 1 month in moderate or severe cases and 2 weeks in mild cases
• also effective in treating recurrent corneal erosion with its anti-inflammatory activity in reducing MMP9 mediators
• has anti-inflammatory activity similar to doxycycline, which has been shown to be an effective treatment for recurrent corneal erosions
• treating meibomian gland disease -- best to put the drop in the eye as opposed to the eyelids, then have the patient gently massage their eyelids; typically dosed BID for 2 days, then QD for 2 to 4 weeks depending on the severity

Staphylococcus is the most common pathogen on the lids and the likely pathogen in conditions such as preseptcal cellulitis and dacryocystitis

• avoid using amoxicillin because of the resistance to it by staph
• prescribe Augmentin (amoxicillin clavulanate, GlaxoSmithKline)
• additional options would be dicloxacillin or a cephalosporin such as Ceclor (cefaclor, Eli Lilly)