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Indian Antibiotic Guideline For Eye Infections

Indian Antibiotic Guideline For Eye Infections

In 2016 National Centre For Disease Control, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with National Treatment Guidelines for Antimicrobial Use in Infectious Diseases.

Following are major recommendation with regards of Antimicrobial use in Eye Infections

 

Eyelid infections Likely organisms First line/ Suggested Regimen Alternate regimen Remarks
Blephritis

 

 

Unclear

S.aureus, S.epidermidis

Lid margin care with baby shampoo & warm compresses 24 hourly. Artificial tears if associated with dry eye.
External Hordeolum


Internal Horedeolum

S. aureus Hot pack
Blephritis

 

 

 

MSSA/ S. epidermidis


MRSA

 

 

Oral Cloxacillin 250-500 mg qid or

Oral Cephalexin 500mg QID


 

Oral Trimethoprim sulphamethoxazole960 mg BD or Linezolid 600mg BD

 

Lid margin care with baby shampoo   & warm  compresses 24 hourly.     Artificial tears if associated with dry eye.

 

 

Cunjuctival infections


Viral conjunctivitis (pink eye)

No antibiotics required treat for symptoms Highly contagious. If pain & photophobia the suggestive of keratitis.
Bacterial conjunctivitis S.aureus, S.pneumoniae, H.influenzae Ophthalmologic solution: Gatifloxacin 0.3%, levofloxacin 0.5%, Moxifloxacin 0.5% 1-2 drops q2h while awake during 1st 2 days, then q4-8h upto 7 days Uncommon causes-

Chlamydia trachomatis N.gonorrhoeae

Corneal infections
Herpes Simplex keratitis H.simplex type 1&2 Trifluridine ophthalmic soln 1drop 2 hourly, up to 9times/day until re-epithilised. then 1 drop 4 hourly upto 5 times/day for total duration of 21days Ganciclovir 0.15% ophthalmic gel for acute herpitic keratitis. Flurescine staining shows topical dendritic figures.30-50% recur within 2yr.
Varicella Zoster ophthalmicus Varicella–zoster virus Famciclovir 500mg BD Or TID OR Valacyclovir 1gm oral TID X 10days Acyclovir 800mg 5 times/d x 10days
Acute bacterial keratitis (No comorbidities) S.aureus, S.pneumoniae, S.pyogenes, Haemophilus spp Moxifloxacin topical(0.5%):1 drop 1 hourly for first 48hr,then reduce as per response Gatifloxacin 0.3% ophthalmic Solution 1drop 1 hourly for 1st 48hrs then reduce as per response Moxifloxacin. Preferable. Treatment may fail against MRSA.
Acute Bacterial (Contact lens users) P.aeruginosa Tobramycin or Gentamicin 14mg/ml + Piperacilin or Ticarcillin eye drops (6- 12mg/mL) q15-60 min around the clock 24-72hr,then slowly reduce frequency Ciprofloxacin ophthalmic 0.3% or        Levofloxacin  ophthalmic 0.5%
Fungal keratitis Aspergillus, Fusarium, Candida and others Natamycin (5%) 1drop 1-2 hourly for several days,then 3- 4 hourly for several days depending on response Amphotericin B (0.15%) 1 drop q1-2 hourly for several days depending on the response Empirical therapy is not recommended.
Protozoan (soft contact lense users) Acanthamoeba spp. Optimal regimen uncertain Suggested –(Chlorhexidine 0.02% or

Polyhexamethylenebiguanide 0.02%) + (Propamidineisethionate 0.1%or Hexamidine 0.1%) eye drops 1drop every 1 hourly hourly during day time, taper according to clinical response

Uncommon.Traum a & soft contact lenses are risk factors
Orbital infections
Orbital cellulitis S.pneumoniae, H.influenzae, M.catarrhalis, S.aureus, Anaerobes,   Group A Streptococcus, Occasionally Gram Negative bacilli post trauma. Cloxacillin 2 gm IV q4h+ Ceftriaxone 2 gm IV q24 hourly+ Metronidazole 1gm IV 12h If Pencillin/Cephalospori n allergy: Vancomycin 1gm iv q12h + levofloxacin 750 mg IV once daily + Metronidazole iv 1gm 24h If MRSA is suspected substitute cloxacillin with Vancomycin
Endophthalmits Bacterial

 

 

 

 

Post-ocular surgery

 

 

 

Hematogenous

S.epidermidis S. aureus, Streptococci, enterococci, Gram- negative bacilli

 

S.pneumoniae, N.meningitidis, S. aureus, Group B streptococcus, K. pneumoniae

Immediate ophthalmological consultation. Immediate vitrectomy+ intravitreal antibiotics (Inj Vancomycin + Inj ceftazidime)

 

Intravitreal antibiotics Inj Vancomycin + Inj ceftazidime + Systemic antibiotics Inj Meropenem 1gm iv q8h /Inj Ceftriaxone 2gm iv q24h + Inj Vancomycin 1g iv q12h

Adjuvant systemic antibiotics ( doubtful value in post cataract surgery endophthalmitis)Inj Vancomycin+ Inj Meropenem

 

 

 

 

 

 

Endophthalmitis Mycotic (Fungal) Candida sp, Aspergillus sp. Intavitreal amphotericin B 0.005-0.01 mg in 0.1 ml Systemic therapy: Amphotericin B 0.7-1mg/kg + Flucytosine 25mg/kg qid Liposomal Amphotericin B 3- 5mg/kg Or Voriconazole Duration of treatment 4-6 weeks or longer depending upon clinical response. Patients with chorioretinitis and ocular involvement other than endophthalmitis often respond to systemically administered antifungals

You can read the full Guideline by clicking on the following link :

http://www.ncdc.gov.in/writereaddata/linkimages/AMR_guideline7001495889.pdf

Source: with inputs
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