Polytrim Dosing for Infected Hordeolum
For an infected hordeolum, Polytrim (polymyxin B sulfate and trimethoprim) should be applied as 1 drop to the affected eye 4 times daily for 7-10 days. 1
Treatment Approach for Infected Hordeolum
Primary Treatment
- Incision and drainage (I&C) is the primary treatment for purulent hordeolum, with antibiotics serving as adjunctive therapy 2
- Topical antibiotics like Polytrim are commonly prescribed for infected hordeola, though evidence suggests conservative measures alone may be equally effective in many cases 3
Polytrim Dosing Regimen
- Apply 1 drop of Polytrim (polymyxin B sulfate and trimethoprim) ophthalmic solution to the affected eye 4 times daily 1
- Continue treatment for 7-10 days to ensure complete resolution of infection 1
- Ensure proper application by gently pulling down the lower eyelid to form a pocket and instilling the drop, then closing the eye for 1-2 minutes to allow absorption 4
Efficacy Considerations
- Polytrim provides broad-spectrum coverage against both gram-positive and gram-negative bacteria commonly implicated in eyelid infections 1
- Clinical studies have shown that 95% of bacterial eye infections treated with trimethoprim-polymyxin B showed improvement or cure within 7 days 1
- However, some studies suggest that newer fluoroquinolones may provide faster resolution of bacterial eye infections compared to Polytrim 4
Alternative Treatment Options
For Patients with Allergies or Poor Response
- Fluoroquinolone drops (e.g., moxifloxacin 0.5%) may be considered as an alternative, applied 3 times daily for 7 days 4
- For MRSA infections, oral treatment options include:
Important Clinical Considerations
When to Consider Systemic Antibiotics
- Consider oral antibiotics when there is:
- Extensive periorbital cellulitis
- Systemic symptoms (fever, malaise)
- Immunocompromised status
- Failure to respond to topical therapy 5
Treatment Monitoring and Follow-up
- Patients should show clinical improvement within 48-72 hours of starting treatment 4
- If no improvement is seen within 72 hours, consider:
- Obtaining cultures to identify causative organism
- Changing to alternative antibiotic therapy
- Reassessing the diagnosis 3
Common Pitfalls
- Overuse of antibiotics for hordeola that would resolve with warm compresses and lid hygiene alone 3
- Inadequate duration of therapy leading to recurrence 1
- Failure to address underlying conditions like blepharitis that may predispose to recurrent hordeola 3
While recent evidence suggests that antibiotics may not significantly improve outcomes compared to conservative measures for uncomplicated hordeola 3, Polytrim remains a commonly prescribed and well-tolerated option for cases with clear signs of infection.