What is the dosage of Fusithalmic (fusidic acid) eyedrops for bacterial conjunctivitis?

Dosage of Fusithalmic (Fusidic Acid) Eyedrops for Bacterial Conjunctivitis

For bacterial conjunctivitis, instill one to two drops of Fusithalmic (fusidic acid) twice daily for 7 days. 1

Recommended Dosage Regimen

• For bacterial conjunctivitis, the FDA-approved dosage of fusidic acid is:

  • Days 1 and 2: One to two drops every two to four hours in the affected eye(s) 1
  • Days 3 through 7: One to two drops four times daily 1

• However, clinical studies have shown that a simplified regimen of one drop twice daily for 7 days is equally effective and offers better compliance 2, 3

Evidence Supporting Twice-Daily Dosing

• Fusidic acid in a carbomer vehicle (as in Fucithalmic) provides long-lasting antibiotic concentration in tear fluid, allowing for the convenient twice-daily application 3
• In comparative studies, 1% fusidic acid viscous drops applied twice daily showed similar clinical and bacteriological efficacy to more frequently dosed antibiotics such as:
  • 0.3% tobramycin applied 4-6 times daily 2
  • 0.5% chloramphenicol applied 6 times daily 3

Compliance and Convenience Benefits

• Patient compliance is significantly better with the twice-daily fusidic acid regimen compared to more frequent dosing schedules, particularly in children (85% vs 47% compliance) 2
• Significantly more patients rate fusidic acid treatment as convenient or very convenient compared to antibiotics requiring more frequent application 2

Clinical Efficacy Considerations

• Mild bacterial conjunctivitis is often self-limiting, but topical antibiotics are associated with earlier clinical and microbiological remission 4
• A 5-7 day course of broad-spectrum topical antibiotic is usually effective for bacterial conjunctivitis 4
• Treatment may reduce transmissibility and allow for earlier return to school for children 4

Special Considerations

• For more severe bacterial conjunctivitis characterized by copious purulent discharge, pain, and marked inflammation, more frequent application may be warranted 4
• For bacterial corneal ulcers (keratitis), a more intensive regimen is recommended:
  • Days 1-2: One to two drops every 30 minutes while awake, plus doses at 4 and 6 hours after retiring 1
  • Days 3-7: One to two drops hourly while awake 1
  • Days 7-9 until treatment completion: One to two drops four times daily 1

Follow-up Recommendations

• For typical bacterial conjunctivitis, patients should be advised to return for follow-up if they note no improvement in 3-4 days 4
• Clinical improvement should be evident within 2-5 days of starting treatment 5, 2

The twice-daily dosing of fusidic acid offers a practical advantage over other antibiotics requiring more frequent application while maintaining comparable clinical efficacy, making it an excellent first-line choice for bacterial conjunctivitis 2, 6.