What is the recommended dosage of ciprofloxacin (fluoroquinolone antibiotic) for treating a corneal abrasion?

From the Guidelines

Ciprofloxacin is not typically recommended as first-line treatment for simple corneal abrasions, but if used for a corneal abrasion with high infection risk, the typical dosage is 1-2 drops of 0.3% ciprofloxacin ophthalmic solution in the affected eye every 2 hours while awake for the first two days, then 1-2 drops every 4 hours while awake for the next 5 days, as supported by the most recent guidelines 1. For uncomplicated corneal abrasions, broad-spectrum antibiotic drops such as polymyxin B/trimethoprim or erythromycin ointment are usually preferred.

Key Considerations

• The treatment should generally continue for 7 days total, as indicated by the preferred practice pattern for bacterial keratitis 1.
• Patients should be advised not to wear contact lenses during treatment, to avoid touching or rubbing the eye, and to follow up with an eye care professional if symptoms worsen or don't improve within 48 hours.
• Ciprofloxacin works by inhibiting bacterial DNA gyrase, preventing bacterial DNA replication, but it's essential to note that fluoroquinolones are generally reserved for more severe eye infections due to concerns about antibiotic resistance and should be used judiciously, as highlighted in the guidelines 1.

Important Recommendations

• Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients presenting with a contact lens-related corneal abrasion, as recommended by the guidelines 1.
• Patching the eye in a patient who wears contact lenses and has a corneal abrasion is not advised because of the increased risk of bacterial keratitis.
• The use of a cycloplegic agent is an often-overlooked adjunctive treatment and may decrease pain as well as synechia formation in bacterial keratitis, as suggested by the guidelines 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Corneal Ulcers: The recommended dosage regimen for the treatment of corneal ulcersis two drops into the affected eye every 15 minutes for the first six hours and then two drops into the affected eye every 30 minutes for the remainder of the first day. On the second day, instill two drops in the affected eye hourly On the third through the fourteenth day, place two drops in the affected eye every four hours. The recommended dosage of ciprofloxacin for treating a corneal ulcer (which may be related to a corneal abrasion) is:

• Two drops into the affected eye every 15 minutes for the first six hours
• Two drops into the affected eye every 30 minutes for the remainder of the first day
• Two drops into the affected eye hourly on the second day
• Two drops into the affected eye every four hours on the third through the fourteenth day 2. Note: The label does not explicitly mention corneal abrasion, but it does provide dosage information for corneal ulcers.

From the Research

Ciprofloxacin Dosage for Corneal Abrasion

• The recommended dosage of ciprofloxacin for treating a corneal abrasion is not explicitly stated in the provided studies.
• However, a study published in 1996 3 compared the clinical efficacy and safety of ciprofloxacin ophthalmic solution 0.3% with a standard therapy regimen for treating bacterial corneal ulcers, and the dosing schedule was:
  • 1 to 2 drops every 30 minutes for 6 hours
  • 1 to 2 drops hourly for the remainder of day 1
  • 1 to 2 drops every hour on days 2 and 3
  • 1 to 2 drops every 2 hours on days 4 and 5
  • 1 to 2 drops every 4 hours on days 6 to 14
• It is essential to note that corneal abrasions can be managed with antibiotic and tetanus prophylaxis, analgesia, and next-day follow up with ophthalmology 4.
• Topical antibiotics, such as ciprofloxacin, may be used to prevent bacterial superinfection, but the evidence is lacking 5.
• A review published in 2022 6 found that the current evidence is insufficient to support any antibiotic regimen being superior to another for preventing ocular infection or accelerating epithelial healing following a corneal abrasion.
• The management of corneal abrasions should focus on pain control, prevention of infection, and healing, and may include the use of topical nonsteroidal anti-inflammatory drugs or oral analgesics 7, 5.