How to administer antibiotic drops with Non-Steroidal Anti-Inflammatory (NSAID) drops?

Administration of Antibiotic and NSAID Eye Drops

When using antibiotic drops with NSAID drops for ophthalmic conditions, administer the drops sequentially with a 5-minute interval between each medication to prevent dilution and washout, ensuring optimal drug delivery to the ocular surface. 1

Proper Administration Technique

Sequential Dosing Protocol

• Space antibiotic and NSAID drops at least 5 minutes apart to allow adequate absorption and prevent the second drop from washing out the first 1
• The order of administration is generally not critical, but consistency helps with adherence 1
• If using more than two types of drops, maintain the 5-minute interval between each medication 1

Step-by-Step Administration for Each Drop

• Position the patient lying down with the affected eye facing upward 1
• Pull down the lower eyelid to create a pocket 1
• Instill drops along the side of the canal until filled, avoiding direct contact between the dropper tip and the eye 1
• Perform gentle tragal pumping (pressing on the cartilage in front of the ear) to eliminate trapped air and ensure proper distribution 1
• Remain in position for 3-5 minutes after instillation to maximize absorption 1
• Wipe off excess drops after the waiting period 1

Critical Safety Considerations

NSAID-Specific Precautions

• Sterile corneal infiltrates can occur when NSAID drops are used without concomitant topical corticosteroids, though microbial keratitis must always be ruled out when infiltrates appear 1
• NSAID drops may delay corneal epithelialization and should be prescribed judiciously 1
• Monitor closely for signs of corneal complications, particularly if the epithelium is not healing as expected 1

Combined Use Benefits and Risks

• The combination of antibiotic and NSAID drops is effective for conditions like traumatic corneal abrasion, providing pain relief while preventing infection 2
• NSAID drops provide sufficient pain control to allow most patients (80%) to return to normal activities immediately when used appropriately 2
• Both medications can be safely used together without significant drug-drug interactions at the ocular surface 3, 2

Common Pitfalls to Avoid

• Never administer drops simultaneously or in rapid succession as this dilutes both medications and reduces therapeutic efficacy 1
• Do not skip the 5-minute waiting period between drops even when patients are in a hurry, as this compromises treatment effectiveness 1
• Avoid self-administration when possible—only 40% of patients who self-medicate do so appropriately during the first 3 days, making assisted administration the preferred method 1
• Do not use NSAID drops if tympanic membrane integrity is uncertain (this applies to otic preparations, not ophthalmic) 1
• Keep the eye dry while using drops and avoid cleaning the treated area yourself to prevent trauma 1

When Additional Intervention is Needed

• If drops do not easily penetrate, the canal may need professional cleaning or wick placement 1
• Aural toilet (cleaning) may be necessary if debris obstructs drug delivery, though this should be performed by a clinician 1
• If a wick is placed, it may fall out spontaneously as inflammation resolves—this is a positive sign 1