Tobradex Drops Dosing Frequency
For mild to moderate bacterial eye infections, instill 1-2 drops of Tobradex every 4 hours; for severe infections, instill 2 drops hourly until improvement, then taper frequency before discontinuation. 1
Standard Dosing Protocol
Mild to Moderate Disease
- Instill 1 or 2 drops into the affected eye(s) every 4 hours 1
- This four-times-daily regimen has been validated in post-surgical prophylaxis studies showing effective control of inflammation and infection 2
Severe Infections
- Instill 2 drops hourly until clinical improvement is observed 1
- For central or severe bacterial keratitis specifically, consider loading doses every 5-15 minutes initially, followed by hourly maintenance dosing around the clock 3
- Treatment should be reduced prior to discontinuation once improvement occurs 1
Monitoring Response and Tapering
Signs of Positive Response (Indicating When to Taper)
Clinical features suggesting you can begin reducing frequency include: 3
- Reduced pain and discharge
- Decreased eyelid edema or conjunctival injection
- Sharper demarcation of stromal infiltrate perimeter
- Decreased density of stromal infiltrate
- Reduced anterior chamber inflammation
Critical Tapering Guidelines
- Do not taper below 3-4 times daily as subtherapeutic dosing increases antibiotic resistance risk 3
- If the eye shows lack of improvement or stabilization within 48 hours, modify therapy rather than continue the same regimen 4, 3
- Note that Pseudomonas and other gram-negative organisms may exhibit increased inflammation during the first 24-48 hours despite appropriate therapy 4
Important Caveats
Toxicity Concerns
- Prolonged use of topical antibiotics causes toxicity and should be tapered as infection improves 4, 3
- Medication toxicity can cause worsening inflammation or even corneal melting 4
- If persistent epithelial defect exists but infection is controlled, add adjunctive therapies like lubrication, antibiotic ointment, or bandage contact lens 3