How to prescribe Tobradex (Tobramycin and Dexamethasone)?

From the Guidelines

Tobradex should be prescribed as an ophthalmic suspension, with a typical dosing regimen of 1-2 drops in the affected eye(s) every 4-6 hours, for a duration of 7-10 days, as this combination of tobramycin and dexamethasone has been shown to reduce signs and symptoms of blepharitis in uncontrolled manufacturer-sponsored studies 1. When prescribing Tobradex, it is essential to specify the formulation, quantity needed, and administration instructions to ensure proper use and minimize potential side effects.

• The formulation should be specified as an ophthalmic suspension, which is a liquid solution that is easier to administer and may be more effective for certain types of eye infections.
• The quantity needed should be determined based on the severity of the infection and the patient's response to treatment, with a typical prescription lasting 7-10 days.
• Administration instructions should include the dosing frequency, which is typically 1-2 drops in the affected eye(s) every 4-6 hours, and the importance of completing the full prescribed course of treatment, even if symptoms improve, to prevent antibiotic resistance and ensure complete resolution of the infection. It's also important to note that Tobradex is a combination medication containing an antibiotic and a corticosteroid, which can increase the risk of certain side effects, such as increased intraocular pressure or cataract progression, as reported in studies comparing the efficacy and safety of different topical treatments for blepharitis 1.
• Patients with advanced glaucoma or a history of glaucoma filtering procedures should be advised to use Tobradex with caution and monitor their intraocular pressure regularly, as mechanically induced irritation can increase eye pressure 1.
• Alternative treatments, such as topical perfluorohexyloctane or selenium sulfide, may be considered for patients with blepharitis or meibomian gland dysfunction, as they have been shown to improve symptoms and corneal staining in clinical trials 1.

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.

To prescribe Tobradex (Tobramycin and Dexamethasone), the dosage is as follows:

• For mild to moderate disease, instill 1 or 2 drops into the affected eye(s) every 4 hours.
• For severe infections, instill 2 drops into the eye(s) hourly until improvement, then reduce treatment prior to discontinuation 2.

From the Research

Prescribing Tobradex (Tobramycin and Dexamethasone)

• Tobradex is a combination antibiotic and steroid eye drop used to treat various eye conditions, including blepharitis, conjunctivitis, and keratoconjunctivitis 3, 4, 5.
• The typical dosage of Tobradex is 1-2 drops, 4-6 times a day, depending on the condition being treated 3, 5.
• In the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis, Tobradex (0.3%/0.05%) was found to provide faster inflammation relief than azithromycin (1%) 3.
• Tobradex (0.3%/0.1%) was also compared to tobramycin (0.3%)/loteprednol (0.5%) in the management of blepharo-keratoconjunctivitis, with Tobradex being more effective in decreasing clinical signs of ocular inflammation 5.
• In a study on viral conjunctivitis, the addition of ozonized oil to Tobradex (0.3%/0.1%) was found to reduce the signs of conjunctivitis and the duration of viral infection, although it did not affect the subepithelial corneal infiltrates appearance 4.

Administration and Safety

• Tobradex is typically administered topically, with the patient instructed to follow the prescribed dosage and administration schedule 3, 5.
• The safety of Tobradex has been evaluated in several studies, with no significant differences in safety profiles compared to other treatments 3, 5.
• However, as with any medication, potential side effects and interactions should be monitored, and patients should be advised to follow the prescribed treatment schedule and report any concerns to their healthcare provider 3, 5.