From the Guidelines
Antibiotic-steroid combination eye drops should be used with caution for treating eye infections with inflammation, as they can potentially worsen certain eye infections like herpes or fungal infections, and their benefits are largely determined by the type of infection and the individual patient's response to therapy. The use of antibiotic-steroid combination eye drops, such as tobramycin-dexamethasone (Tobradex), neomycin-polymyxin B-dexamethasone, and ciprofloxacin with dexamethasone, may be beneficial in treating some cases of microbial keratitis, particularly Pseudomonas keratitis and more severe cases of bacterial keratitis 1. However, the Steroids for Corneal Ulcer Trial (SCUT) found no benefit of concurrent topical corticosteroid therapy using prednisolone phosphate 1% in conjunction with broad-spectrum topical antibiotic, and treatment of Nocardia keratitis with corticosteroids resulted in poor visual outcomes 1.
When using antibiotic-steroid combination eye drops, it is essential to follow a standard regimen, which typically involves applying 1-2 drops into the affected eye(s) 4-6 times daily for 7-10 days. It is also crucial to wash hands before application, pull down the lower eyelid to create a pocket, instill the drops, close eyes gently for 1-2 minutes, and apply gentle pressure to the inner corner of the eye to prevent systemic absorption. The antibiotic component kills bacteria, while the steroid reduces inflammation, redness, and discomfort. However, it is vital to use these medications under medical supervision, as steroids can potentially worsen certain eye infections.
Some key considerations when using antibiotic-steroid combination eye drops include:
- Using the minimum amount required to achieve control of inflammation
- Optimal timing and careful dose regulation
- Use of adequate concomitant antibacterial medication
- Close follow-up to monitor the patient's response to therapy and potential adverse events 1
- Avoiding touching the dropper tip to prevent contamination, and discarding the bottle one month after opening
- Completing the full course of treatment even if symptoms improve, and contacting the doctor if symptoms worsen or don't improve within 48 hours.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: In mild to moderate disease, instill 1 or 2 drops into the affected eye(s) every 4 hours. In severe infections, instill 2 drops into the eye(s) hourly until improvement, following which treatment should be reduced prior to discontinuation. The FDA drug label does not answer the question.
From the Research
Treatment for Eye Infections
The treatment for eye infections using antibiotic eye drops with steroid involves the use of a combination of anti-infective and anti-inflammatory agents.
- Antibiotic eye drops are used to treat bacterial infections, while steroids are used to reduce inflammation and swelling.
- The use of antibiotic eye drops with steroid has been shown to be effective in treating acute conjunctivitis, with studies indicating that they can improve clinical and microbiological remission rates 2, 3.
- However, the use of steroids in eye infections is generally recommended for short-term treatment (≤2 weeks) due to the potential risks associated with long-term use, such as increased intraocular pressure, glaucoma, and cataracts 2.
Types of Antibiotic Eye Drops with Steroid
There are several types of antibiotic eye drops with steroid available, including:
- Loteprednol etabonate 0.5%/tobramycin 0.3% ophthalmic suspension, which has been shown to be effective and well-tolerated in the treatment of ocular surface inflammatory conditions 4.
- Dexamethasone-netilmicin, a new ophthalmic steroid-antibiotic combination that has been shown to be effective and safe in controlling ocular inflammation after cataract surgery 5.
- Corticosteroid-antibacterial combination drugs, such as those containing dexamethasone and tobramycin, which are used to suppress ocular inflammation and treat bacterial infections 6.
Safety and Efficacy
The safety and efficacy of antibiotic eye drops with steroid have been evaluated in several studies, with results indicating that they are generally well-tolerated and effective in treating eye infections.
- A study on the use of loteprednol etabonate 0.5%/tobramycin 0.3% ophthalmic suspension found that it was associated with a high level of safety and efficacy in the management of ocular surface inflammatory conditions 4.
- Another study on the use of dexamethasone-netilmicin found that it was effective and safe in controlling ocular inflammation after cataract surgery, with no evidence of poor local tolerance or adverse reactions 5.