Preparation of fortified eye

drops
Dr Sushmita G Shah
DNB(Sankara Nethralaya), FICO, FLVPEI
Fellow Cornea – Mass. Eye & Ear Infirmary, Boston, USA

Consultant Cornea & Anterior Segment

Surgeon
Eye Life Eye Hospital, Khar(W), Mumbai
Netra Mandir, Mumbai

No financial interests
 Purpose
• Fortification – dictionary meaning
• the act, art, or science of fortifying or strengthening
• Fortification of antibiotics may be required
1. To achieve the MIC levels for pathogens which
may be difficult with the usual 0.3% / usual strength
topical antibiotics
2. Drug resistant cases
3. In large and severe ulcers
4. Drug is available in parenteral form and not as
topical drops
Drawbacks of fortification

Gokhale NS. Ind J Ophthalmol

 General instructions
• Should be done by doctor or pharmacist inside a
laminar air hood under aseptic precautions
conditions
• Disposable syringe should be used
• All drops should be labelled
• Date of preparation and date of expiry should be
mentioned
• Prescription describing frequency of application etc
should also be given to the patient
• Storage instructions should also be given
 Fortified
Aminoglycosides
Fortified Rx ADD Final Storage Shelf life
Concentrati
on
Tobramycin Tobramycin Inj. Tobramycin 4deg C 1 week in
(1.4%) 0.3% eye Tobramycin 95 mg in 7 Fridge
drop -2ml/80mg ml – 1.4% 4 days in room
- 15mg in 5 temperature
ml

Gentamycin Gentamicin Inj. Gentamicin 4deg C 1 week in

(1.4%) 0.3% Gentamicin 95 mg in 7 Fridge
eye drop -2ml/80mg ml - 1.4% 4 days in room
- 15mg in 5 temperature
ml
 Fortified
Aminoglycosides
Fortified Add Final Tempera Stability
Rx concentration ture

Amikacin Inj Amikacin 8ml Amikacin 4deg C 7 days

2.5% 250mg/2ml artificial 250mg/10ml –
tears 2.5%
 Fortified Cephalosporins
Drug ADD
Fortified Inj. 10 ML 500mg in 10 4 deg C 1 week
Cefazolin Cefazolin – artificial ml – 5%
5% 5oomg tears Fortified
Cefazolin
Fortified Inj 10 ML 500mg in 10 4 deg C 1 week
Ceftazidime Ceftazidime artificial ml – 5%
5% 500mg tears Fortified
Ceftazidime
 Topical Linezolid 0.2%
• Lancure / Adlid /Rapidline IV infusion
• 200mg/100ml

• Topical ophthalmic dosage – 0.2%(2mg/ml)

• Indications –
• Methicillin resistant Staphylococcus aureus keratitis
• Corneal surface toxicity less than topical
Vancomycin

Tas T. Cornea 2013

 Topical Vancomycin 5%
• Available as Inj Vancomycin HCL – 500mg
• Add 2ml sterile water for reconstitution
• Add 8ml artificial tears
• 50mg/ml – 5% Vancomycin
• Stabilty – 28 days at 4deg C

• Methicillin resistant Staphylococcus aureus keratitis

• Corneal surface toxicity – greatest drawback
 Topical colistin 0.19%
• Inj Xylistin – Colistimethate sodium powder
• 1million IU/75mg
• Added to 10ml distilled water – 75mg/ml(0.75%)
• 1ml of above solution + 3ml distilled water –
0.19% Colistin drops

• For pandrug/multidrug resistant Pseudomonas

aeruginosa keratitis
Topical Imipenem-cilastin
1%
• Inj. Imipenem(500mg) + Inj Cilastin (500mg)
• Add 10ml sterile water – 50mg/ml
• Take 1 ml of this solution and add 4 ml sterile water
• Topical Imipenem 1% - 1mg/ml
• Store in amber coloured bottles
• Stability – 3 days at 2-8 deg C
 Topical Voriconazole 1%
• 200mg of Voriconazole powder
• Add 19ml normal saline
• Voriconazole 1% eye drop
• Stable – 30days at 4deg C or room temperature
• Intracameral voriconazole inj. - 10µgm/ml to
10mg/ml concentration of Voriconazole has been
described.
• Also available from Aurolab
Intrastromal Voriconazole
• 50 µgm/0.1ml
• From1% solution, take 0.5ml, add 0.5ml sterile water
• 5mg/ml – take 0.1ml,add 0.9ml – 0.5mg/ml
• 0.5mg/ml – take 0.1ml, add 0.9ml – 0.05mg/ml
• 50 µgm/0.1ml
 Topical Amphotericin B
0.15%
• 50mg Amphotericin B powder
• Add 10ml sterile water – 5mg/ml
• Take 3ml of this solution and add 7ml artificial tears
– 1.5mg/ml = 0.15%
• Storage – 7 days at 4deg C
 Intracameral
Amphotericin
• 5 -10 µgm/0.1ml injected
• Reconstituition in 5% Dextrose or sterile water
• From 5mg/ml solution – take 0.1ml solution
• Add 0.9ml 5%Dextrose / sterile water
• Again take 0.1ml and add 0.9ml 5%Dextrose/Sterile
water
• 5 µgm/0.1ml
• Same concentration is used for intrastromal
injection
• Thank you

• sushmitagshahin@gmail.com