Instruction manual for preparation of fortified antimicrobial eye drops
General Instructions
- Should be done by doctor or pharmacist inside a laminar air hood under aseptic precautions. If laminar air hood is not available, please prepare in the operation room
- Disposable syringe should be used
- All drops should be labelled ‐ date of preparation and date of expiry should be mentioned
- Prescription describing frequency of application etc should also be given to the patient
- Storage instructions should also be given. Drops which are to be refrigerated at 4degC can be kept on the refrigerator door.
Aminoglycosides
1. Fortified Tobramycin: 14 mg/ml(1.4%)
Method: Add 2ml/80mg of parenteral tobramycin to commercially available tobramycin eye drops 0.3% 5 ml (15mg/5ml).
Shelf Life: 1 week in refrigerator at 4 degrees and 4 days in room temperature
2. Fortified Gentamicin Eye Drops: 14 mg/ml(1.4%)
Method: Add 2ml/80mg of parenteral gentamicin to commercial gentamicin ophthalmic solution 0.3% 5 ml (15mg/5ml).
Shelf Life: 1 week in refrigerator at 4 degrees C and 4 days in room temperature
3. Fortified Amikacin Eye Drops: 2.5%
Method: Parenteral Amikacin 250mg/2ml is mixed with 8 ml artificial tears.
Shelf Life: 7 days under refrigeration at 4 Degrees Centigrade
Cephalosporins
1. Fortified Cefazolin Eye Drops: 50mg/ml( 5%)
Method: Reconstitute parenteral Cefazolin 500mg with 2ml sterile water available with the injection and add to 8ml of artificial tears.
Storage: Refrigerate in 4 degrees C.
Shelf Life: 1 week in refrigeration at 4 degrees C and 4 days in room temperature
2. Fortified Ceftazidime eye drops: 50mg/ml( 5%)
Method: Reconstitute parenteral Ceftazidime 500mg with 2ml sterile water/BSS available with the injection and add to 8ml of artificial tears.
Storage: Refrigerate in 4 degrees C.
Shelf Life: 1week under refrigeration at 4 degrees C and 3 days in room temperature
Topical Vancomycin Eye Drops: 50mg/ml(5%)
Method: Reconstitute 500mg of vancomycin powder for injection with 2 ml sterile water/BSS. Add to 8ml of artificial tears.
Storage: Refrigerate at 4 Degrees C.
Shelf Life: 28 days at 4 Degrees C
Topical Linezolid 2 mg/ml (0.2%)
Method: Can use directly from parenteral Linezolid (Lancure / Adlid /Rapidline) available as 200mg/100ml (2mg/ml) IV infusion.
Topical Colistin 0.19%
Method: Prepared from parenteral Colistimethate sodium powder (Xylistin) 1million IU/75mg
Added to 10ml distilled water – 7.5mg/ml (0.75%)
1ml of above solution is then added to 3ml distilled water – 0.19% Colistin drops
Topical Imipenem–Cilastin eye drops 1%
Method: To parenteral Imipenem(500mg)-Cilastin (500mg), add 10ml sterile water to create a solution of strength 50mg/ml.
Take 1 ml of this solution and add 4 ml sterile water to make topical Imipenem 1% - 1mg/ml
Storage - In amber coloured bottles
Stability – 3 days at 2-8 deg C
Topical Amphotericin B 0.15%
Method: Add 10 ml distilled or sterile water to parenteral 50mg of amphotericin B powder for injection.
Draw 3 ml of this and add to 7ml of artificial tears eye drops.
Storage: Refrigerate in 4 degrees.
Shelf life: 7 days in refrigerator at 4 degrees C and 4 days in room temperature.
Amphotericin B 5 -10 μgm/0.1ml for intracameral injection
To reconstitute 10 μgm/0.1ml :
Method: Reconstituted in BSS or sterile water
From 5mg/ml solution of Amphotericin B (as mentioned above) – take 0.2ml solution and add 0.8ml BSS / sterile water.
Now, take 0.1ml of this solution and add 0.9ml BSS/Sterile water to create 0.1mg/1ml Amphotericin B equivalent to 10 μgm/0.1ml.
Use immediately.
Amphotericin B 5 -10 μgm/0.1ml for intrastromal injection
Method: Same concentration as is used for intrastromal injection
Topical Voriconazole Eye Drops 1%
Method: Mix 20 ml ringer lactate to 200 mg voriconazole lyophilized powder.
Label: Voriconazole eye drops 1%
Stability: 30days at 4deg C or room temperature
Voriconazole for intrastromal injection 50 μgm/0.1ml
Method: From1% solution voriconazole, take 1ml, add 19 ml ringer lactate to make 0.05mg/ml (50 μgm/0.1ml)
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