What eye antibiotic ointment has similar coverage to Maxitrol (neomycin and polymyxin B sulfates and dexamethasone)?

From the Guidelines

Tobramycin-dexamethasone (TobraDex) is a suitable alternative to Maxitrol, providing comparable antibacterial and anti-inflammatory effects for the treatment of bacterial eye infections and inflammation. For patients requiring antibiotic coverage without steroids, erythromycin ophthalmic ointment, bacitracin, or ciprofloxacin ointments are viable options, as noted in the blepharitis preferred practice pattern 1. The typical dosing for these alternatives involves applying a small ribbon (about 1/4 inch) to the lower eyelid 2-4 times daily for 7-10 days, or as directed by the healthcare provider, to ensure complete treatment and prevent recurrence or resistance 1. These medications function by inhibiting bacterial protein synthesis or disrupting bacterial cell membranes, while the steroid component in combination products reduces inflammation. It is crucial to complete the full course of treatment even if symptoms improve early and to consult a healthcare provider immediately if increased pain, vision changes, or worsening symptoms occur after 48 hours of treatment. The choice of antibiotic ointment should be guided by the severity of the blepharitis and response to treatment, with the option to repeat treatment on an intermittent basis using different medications to prevent the development of resistant organisms 1. Topical administration of loteprednol etabonate 0.5%/tobramycin 0.3% suspension has been shown to improve blepharoconjunctivitis in adults and is considered a safer medication compared to dexamethasone due to less risk of intraocular pressure rise or cataract progression 1. In cases where oral antibiotics are necessary, doxycycline, minocycline, or tetracycline can be given daily and tapered after clinical improvement is noted, with the option to use oral erythromycin or azithromycin in women of childbearing age and in children to avoid the use of tetracyclines 1.

From the Research

Eye Antibiotic Ointments

• There are several eye antibiotic ointments available with similar coverage to Maxitrol, including:
  • Trimethoprim-polymyxin B (TP) 2
  • Gentamicin sulfate (GS) 2
  • Sodium sulfacetamide (SS) 2
  • Fluorometholone-Gentamicin eye drops 3
• These ointments have been shown to be effective against various bacterial infections, including:
  • Haemophilus influenzae 2
  • Streptococcus pneumoniae 2
  • Staphylococcus aureus 4, 5, 3
  • Pseudomonas aeruginosa 4, 2, 3
• However, the effectiveness of these ointments against multi-drug resistant organisms (MDROs) may be reduced 6
• It is essential to note that the susceptibility of bacteria to topical antimicrobials can vary, and some MDROs may be more resistant to certain topicals than non-MDROs 6

Comparison of Eye Antibiotic Ointments

• A study comparing Maxitrol (dexamethasone, neomycin, polymyxin B) with Fluorometholone-Gentamicin eye drops found that Fluorometholone-Gentamicin was more effective in reducing ocular bacterial flora after cataract surgery 3
• Another study comparing Maxitrol with Maxidex (dexamethasone alone) found that Maxitrol was more effective in reducing bacterial counts and conjunctival discharge in patients with chronic blepharitis or conjunctivitis 5
• A study evaluating the effectiveness of various topical antimicrobials against MDROs found that while many topicals were still effective, MDROs were more resistant to topicals than non-MDROs 6