What is the recommended dosing regimen for Maxitrol (dexamethasone/neomycin/polymyxin B) ophthalmic suspension in adults and children?

Maxitrol Dosing Regimen

Administer Maxitrol (dexamethasone 0.1%/neomycin/polymyxin B) ophthalmic suspension 1–2 drops into each affected eye four times daily for bacterial blepharitis and inflammatory ocular conditions where infection risk exists. 1

Standard Dosing Schedule

• Instill 1 drop in the affected eye(s) four times daily at approximately 6-hour intervals for acute bacterial conjunctivitis or blepharoconjunctivitis 1, 2
• Treatment duration should be guided by clinical response, typically ranging from 5–7 days for acute conjunctivitis to several weeks for chronic blepharitis 1, 3
• For chronic blepharitis, symptoms frequently recur after discontinuation, requiring intermittent reinstatement based on severity 1

Pediatric Dosing

• The dosing regimen is identical in children and adults: 1 drop four times daily 1, 3
• Maxitrol is safe and effective in pediatric patients aged ≥1 year with bacterial conjunctivitis 3
• Children can typically return to school after 24 hours of treatment initiation when symptoms begin improving 1

Duration and Monitoring Considerations

• Do not continue treatment beyond 2 weeks without reassessment for alternative diagnoses or resistant pathogens 1
• If therapy extends beyond 8 weeks, switch to loteprednol etabonate 0.5%/tobramycin 0.3% (Zylet), which carries lower risk of intraocular pressure elevation and cataract progression compared to dexamethasone 1, 4
• Regular intraocular pressure monitoring is essential during prolonged corticosteroid use, as dexamethasone carries significant risk of steroid-induced glaucoma 1

Critical Contraindications

• Never use Maxitrol as monotherapy for bacterial keratitis—it requires fortified antibiotics and specialist management 1
• Contraindicated in viral ocular diseases (epithelial herpes simplex keratitis, vaccinia, varicella) 1
• Contraindicated in mycobacterial and fungal eye infections 1
• Active corneal ulceration or epithelial defects require immediate ophthalmology referral; do not use Maxitrol 1
• Avoid preserved formulations when epithelial defects are present, as preservatives worsen epithelial damage 1
• Do not combine with eye patching, especially in contact-lens wearers, due to increased bacterial keratitis risk 1

Antibiotic Stewardship

• Rotate antibiotic formulations intermittently using agents with different mechanisms of action to prevent resistant organisms 1, 4
• Avoid chronic prophylactic use without clear indication, as this promotes methicillin-resistant Staphylococcus aureus 1
• Maxitrol produces 90% reduction in bacterial counts and 50% bacterial eradication in chronic blepharitis, significantly superior to dexamethasone alone (34% reduction, 17% eradication) 5

Mandatory Referral Criteria

Immediate ophthalmology referral is required for:

• Severe or moderate-to-severe pain 1
• Lack of clinical response after 3–4 days of therapy 1
• Severe purulent discharge 1
• Contact-lens wearers with bacterial conjunctivitis (higher complication risk) 1

Common Pitfalls to Avoid

• Never prescribe Maxitrol for active viral keratitis—corticosteroids exacerbate viral infections 1
• Do not use in patients with corneal ulceration—this requires specialist management with fortified antibiotics 1
• Be aware that long-term neomycin use carries risk of contact dermatitis and hypersensitivity reactions 5
• Dexamethasone carries higher risk of IOP elevation than loteprednol; consider switching for extended therapy 1, 4