Tobradex Ointment Application Frequency
Tobradex (tobramycin and dexamethasone) ointment should be applied one or two drops into the conjunctival sac(s) every four to six hours, with increased frequency to every two hours during the initial 24-48 hours if needed for severe cases. 1
Dosing Guidelines
- The FDA-approved dosing for Tobradex ointment is one or two drops instilled into the conjunctival sac(s) every four to six hours 1
- During the initial 24 to 48 hours of treatment, the dosage may be increased to one or two drops every two hours for more severe infections 1
- Frequency should be decreased gradually as warranted by improvement in clinical signs 1
- Care should be taken not to discontinue therapy prematurely to prevent recurrence of infection 1
Clinical Response Indicators
The following clinical features suggest a positive response to antibiotic therapy, indicating when dosing frequency can be tapered:
- Reduced pain and discharge 2
- Lessened eyelid edema or conjunctival injection 2
- Consolidation and sharper demarcation of the perimeter of any stromal infiltrate 2
- Decreased density of the stromal infiltrate in the absence of progressive stromal loss 2
- Reduced stromal edema and endothelial inflammatory plaque 2
- Reduced anterior chamber cells, fibrin, or hypopyon 2
- Initial re-epithelialization 2
- Cessation of progressive corneal thinning 2
Important Considerations
- Modification of therapy (type, concentration, or frequency) should be considered if the eye shows a lack of improvement or stabilization within 48 hours 2
- Most antibiotic eye drops should not be tapered below 3 to 4 times a day because low doses are subtherapeutic and may increase the risk of developing antibiotic resistance 2
- Prolonged use of topical antibiotics can cause toxicity, so they should be tapered as the infection improves 2
- Medication toxicity can cause worsening inflammation or even corneal melting 2
- For severe corneal infections, more aggressive dosing may be required, such as loading doses every 5-15 minutes followed by hourly applications 3
Special Situations
- For blepharitis treatment, Tobradex ointment has been shown to improve signs and symptoms when applied to the eyelid 4
- For post-surgical inflammation control after cataract surgery, Tobradex has demonstrated superior efficacy when administered four times daily 5
- For patients with persistent epithelial defects where infection is under control, adjunctive therapies to rehabilitate the surface should be instituted, such as lubrication, antibiotic ointment, bandage contact lens, amniotic membrane coverage, or tarsorrhaphy 2
Monitoring and Follow-up
- Regular follow-up is essential to monitor response to treatment and adjust dosing accordingly 2
- Intraocular pressure should be monitored, especially with prolonged use, as some patients may experience elevated pressure (reported in 3.7% of patients in one study) 4
- Not more than 20 mL should be prescribed initially, and the prescription should not be refilled without further evaluation 1