FQs for Conjunctivitis:
- Cipro, Levo, OFLOX?
- Moxi, Besiflox?
- Moxeza?
- ZymaxID (Gatiflox)?
- Cipro/Levo/Oflox: Days 1-2: 1-2gtt q2h (awake). Day 3-10: 1gtt QID
- Moxi, Besi: 1gtt TID x7D
- Moxeza: 1gtt BID x7D (kids!)
- ZymaxID: Day 1: 1-2gtt q2h (awake). Days 2-7: 1gtt QID
Note: Levoflox NOT approved if under 6 Y/O
Aminoglycosides for Conjunctivitis:
(TOBRAMYCIN - GM-, some GM+)
-Mild?
-Severe?
mild: 1gtt q4h x7-10D
severe: 1gtt q2h until improvement, then q4h for remainder of 10D
- E-mycin oint dosing for conj?
- Azasite dosing for conj?
q3-4h x7D
1gtt BID x2d, then QD x5d
-POLYTRIM (MRSA-suspicious) conj. dosing?
-1gtt q3h x7-10d
Neonatal conjunctivitis:
- Use ___ if GM+
- Use ___if GM-
- Use ___ IV/IM if N. gonorrhea (dosing?)
GM+ : E-mycin
GM- : Tobramycin
N. Gonorrhea: Ceftriaxone IV/IM 30-50mg/kg/day divided doses (3rd gen ceph), don’t exceed 125mgs; eye irrigation
Only fortifiable topical FQ antibiotic for keratitis? Indicated in conjunctivitis?
Levofloxacin (Levoquin; Iquix) - NOT approved for conjunctivitis; only keratitis –> limited GM- coverage.
Recommended drug class for keratitis? Specifically WHICH drug if MRSA suspected?
- Dosing mild-mod keratitis?
- Dosing severe keratitis?
4th gen FQs - recommended - but OFF-LABEL
MRSA-specific: BESIFLOXACIN (Vigamox if not suspicious)
- mild-mod: 1gtt q30min x24h CONTINUOUS, then q2h after epi healed
- severe: 1gtt q5min x30 mins, THEN same as above (1gtt q30min for remaining 24hrs, then q2h after re-epi)
- F/U EVERY 24H until healed
after keratitis is healed, how long do you continue use of FQs?
Dosing for the following (how many times/day)?
- moxiflox, besiflox?
- moxeza?
- polytrim?
- polysporin?
5 days
- moxi/besi: TID
- moxeza: BID
- polytrim: q3h
- polysporin (supplement in severe keratitis)
In-office Tx of a small (
-4th gen FQ (Vigamox, Besiflox)
AND
-Tobramycin for extra GM- coverage (aminoglycoside)
Dosing:
-1gtt FQ, then 1gtt Tobramycin 5 mins later every 30-60 mins CONTINUOUS for the first 24h, then q2h
FORTIFIED COMBO therapy (SIGHT-THREATENING ULCER)
-central/paracentral, MRSA-suspected, moderate-severe CL-related ulcer
- Dosing regimen if GM+?
- Dosing regimen if GM-?
GM+ : fortified VANCO, fortified TOBRA
GM- : fortified TOBRA, fortified cephazolin (GABHS)
Three drugs used in Neisseria gonorrhea?
-what’s the addnl DOC if accompanied by chlamydia?
CEPHTRIAXONE (rocephin) - DOC
- addnl tobramycin, moxiflox of ceftazadime
- azithromycin (1g single dose)
Adjuvant therapy: DOC for cycloplegia?
- DOC for pain mgmt?
- DOC for ACUTE (
cyclo: atropine
pain: Ultram - (tramadol) (opioid!) - 17Y/O or older, NO effect on Heart rate
acute extreme pain - Ultracet (tramadol/APAP)
CRUCIAL to r/o before Rx’ing steroid for bacterial keratitis?
R/O ACANTHAMOEBA & FUNGAL origin
-use MINIMUM effective dose (QID)
Caution: what FQ is known to cause corneal crystalline deposits?
Ciprofloxacin (ciloxan) - so be careful if you use it for an ulcer
Tx of HSV EPI Keratitis - topicals:
- Dosing of Zirgan, Zovirax (acyclo oph), and Vira-A (obsolete d/t toxicity) - ALL ___/day until healed, then ___ x__ days
- Dosing of Viroptic?
Zirgan, Zovirax, Vira-A: 5x/day until healed then, TID x7 days
Viroptic: 9x/day until healed, then 4x/day x7 days
Tx of STROMAL keratitis/endotheliitis? (just names, not doses)
COMBO topical antiviral (HEDS)
-Viroptic or Zirgan x1 wk, THEN topical steroid for 2nd/3rd week
ACTIVE HSV dosing for ORAL:
- acyclovir tab:
- acyclovir syrup:
- valacyclovir:
- famcyclovir:
- acyclo tab: 400mg PO 5x/day x7-10d
- acyclo syrup: 200mg “
- valacyclo: 1000mg BID x7-10d
- famvir: 500mg BID x7-10d
PROPHYLAXIC HSV ORALS:
- acyclovir tab:
- acyclovir syrup:
- valacyclovir:
- famcyclovir:
- acyclo tab: (400mg) BID x12-18mo
- acyclo syrup: 200mg “
- valacyclo: 500 (half) “
- famvir: 250 (half) “
