Azelastine Hydrochloride

Azelastine hydrochloride is an antihistamine that, in

addition to its histamine H1-receptor-blocking activity,
appears to inhibit the release of inflammatory mediators
from mast cells. It is used topically in the symptomatic
relief of allergic conditions including rhinitis
(p.565) and conjunctivitis (p.564).
In the USA, it is licensed for the treatment
of allergic conjunctivitis in adults and children
aged 3 years and over. Regardless of the age and indication,
a 0.05% solution is instilled into each eye twice
daily; this may be increased to four times daily in severe
conditions.

Brinzolamide
Brinzolamide is a carbonic anhydrase inhibitor with
actions and uses similar to those of dorzolamide
(p.1880). It is used to reduce intra-ocular pressure in
the management of open-angle glaucoma and ocular
hypertension (p.1873), either alone or as adjunctive
therapy with a topical beta blocker. A 1% suspension is
instilled into the eye two or three times daily.
Adverse Drug Reactions::: Temporary blurred vision upon instillation, bitter, sour or unusual
taste; blepharitis, dermatitis, dry eye, foreign body sensation, headache, hyperemia, ocular
discharge, discomfort, keratitis, pain, pruritus & rhinitis.

Ciprofloxacin
bacteria, ciprofloxacin may be active in vitro against
Enterobacteriaceae, including Escherichia coli and
Citrobacter, Enterobacter, Klebsiella, Proteus, Providencia,
Salmonella, Serratia, Shigella, and Yersinia
spp. It may also exhibit activity against Pseudomonas
aeruginosa and Neisseria gonorrhoeae. H. influenzae,
Moraxella catarrhalis (Branhamella catarrhalis), and
N. meningitidis are all sensitive. Other Gram-negative
aerobic bacteria reported to be sensitive to ciprofloxacin
have included Gardnerella vaginalis, Helicobacter
pylori, Legionella spp., Pasteurella multocida,
and Vibrio spp. Variable activity has been reported
against Acinetobacter spp., Brucella melitensis, and
Campylobacter spp.
Among Gram-positive aerobic bacteria, ciprofloxacin
is active against staphylococci, including penicillinaseproducing
and penicillinase-nonproducing strains, and
against some MRSA. Streptococci, in particular Streptococcus
pneumoniae and enterococci, are less susceptible.
Other Gram-positive bacteria sensitive to ciprofloxacin
in vitro are Bacillus spp.; variable activity has
been noted for Corynebacterium spp.
Most anaerobic bacteria, including Bacteroides fragilis
and Clostridium difficile, are resistant to ciprofloxacin,
although some other Clostridium spp. may be susceptible.
Ciprofloxacin has some activity against mycobacteria,
mycoplasmas, rickettsias, Chlamydia trachomatis, and
Ureaplasma urealyticum.

For corneal ulcers and superficial ocular infections
caused by susceptible strains of bacteria ciprofloxacin
is given as the hydrochloride in eye drops and eye ointment
containing the equivalent of 0.3% of ciprofloxacin
Corneal ulcer 2 drops every 15 min for 1st 6 hr then 2 drops every 30 min for remainder of 1st
day. 2nd day: 2 drops hrly. 3rd-14th day: 2 drops 4 hrly. Conjunctivitis 1or 2 drops in the
conjunctival sac 2 hrly for 2 days, & 1-2 drops 4 hrly for next 5 days.

Local burning or discomfort, white crystalline precipitates which resolve; lid margin crusting,
crystals/scales, foreign body sensation in the eye; itching, conjunctival hyperemia & bad taste
after installation.


acetylcysteine
In the treatment of dry eye (p.2140) associated with
abnormal mucus production, acetylcysteine, usually as
a 5% solution with hypromellose, is given topically 3
or 4 times daily. Higher concentrations have been used
in some centres.

aciclovir
Aciclovir is active against herpes simplex virus type 1
and type 2 and against varicella-zoster virus
The Epstein-Barr virus and CMV are also susceptible
to aciclovir to a lesser extent
In herpes simplex
keratitis a 3% eye ointment may be applied 5 times
daily until 3 days after healing
Eye application may produce stinging, superficial punctate keratopathy, blepharitis or
conjunctivitis.
Betamethasone
Betamethasone sodium phosphate is also used in the
topical treatment of allergic and inflammatory conditions
of the eyes, ears, or nose, usually as drops or ointment
containing 0.1%.
Adrenal suppression may occur after very short courses of highdose
therapy and since many patients undergoing such therapy
will be under continuing stress when the drugs are stopped, gradual
withdrawal of corticosteroids over 5 to 7 days is preferable
Initially 1-2 drops/hr during the day & every 2 hr at night. Reduce to 1 drop 4 hrly & then to 1
drop 3-4 times daily.
Ophth Allergic and inflammatory conditions of the eye As 0.1% soln: As Na phosphate: Instill 1-
2 hrly until symptoms are controlled. As 0.1% oint: As Na phosphate: Apply 2-4 times/day or at
night w/ the eye drops.
Adverse Drug Reactions:: Rise in intraocular pressure, hypersensitivity reactions, blurred vision,
posterior subcapsular cataracts formation.

Betaxolol Hydrochloride
Eye drops containing the equivalent of 0.25 or 0.5%
betaxolol as the hydrochloride are instilled twice daily
to reduce raised intra-ocular pressure in ocular hypertension
and open-angle glaucoma.
1 drop twice daily.
Adverse Drug Reactions Rare instances of decreased corneal sensitivity, erythema, itching,
corneal punctate staining, keratitis, anisocoria, photophobia, dryness, tearing, discomfort.

Tobramycin
Tobramycin is reported
to be somewhat more active in vitro than gentamicin
against Pseudomonas aeruginosa and less active
against Serratia, staphylococci, and enterococci
Tobramycin may be used as a 0.3% eye ointment or
eye drops in the treatment of eye infections.
Mild to moderate disease 1-2 drops 4 hrly. Severe infections 2 drops hrly until improvement,
reduce prior to discontinuation.

Chloramphenicol
Chloramphenicol is a bacteriostatic antibiotic with a
broad spectrum of action against both Gram-positive
and Gram-negative bacteria, as well as some other organisms
Spectrum of activity. Chloramphenicol has activity
against many types of bacteria, although in most cases
there are less toxic alternatives available. The following
pathogens are usually susceptible (but see also Resistance,
below).
Gram-positive cocci including staphylococci such as
Staph. epidermidis and some strains of Staph. aureus,
and streptococci such as Str., pneumoniae, Str. pyogenes,
and the viridans streptococci. Meticillin-resistant
staphylococci and Enterococcus faecalis are commonly
found to be resistant.
Other Gram-positive species including Bacillus anthracis,
Corynebacterium diphtheriae, and anaerobes
such as Peptococcus and Peptostreptococcus spp. are
usually susceptible.
Gram-negative cocci such as Neisseria meningitidis
and N. gonorrhoeae are usually highly sensitive, as are
Haemophilus influenzae and a variety of other Gramnegative
bacteria including Bordetella pertussis, Brucella
abortus, Campylobacter spp., Legionella pneumophila,
Pasteurella, and Vibrio spp. The Enterobacteriaceae
vary in their susceptibility, and many strains
have shown acquired resistance, but Escherichia coli,
and strains of Klebsiella spp., Proteus mirabilis, Salmonella,
Shigella, and Yersinia spp. have been reported
to be susceptible. Many strains of Enterobacter, indole-
positive Proteus, and Serratia spp. are resistant,
or at best moderately susceptible. Pseudomonas aeruSpectrum of activity. Chloramphenicol has activity
against many types of bacteria, although in most cases
there are less toxic alternatives available. The following
pathogens are usually susceptible (but see also Resistance,
below).
Gram-positive cocci including staphylococci such as
Staph. epidermidis and some strains of Staph. aureus,
and streptococci such as Str., pneumoniae, Str. pyogenes,
and the viridans streptococci. Meticillin-resistant
staphylococci and Enterococcus faecalis are commonly
found to be resistant.
Other Gram-positive species including Bacillus anthracis,
Corynebacterium diphtheriae, and anaerobes
such as Peptococcus and Peptostreptococcus spp. are
usually susceptible.
Gram-negative cocci such as Neisseria meningitidis
and N. gonorrhoeae are usually highly sensitive, as are
Haemophilus influenzae and a variety of other Gramnegative
bacteria including Bordetella pertussis, Brucella
abortus, Campylobacter spp., Legionella pneumophila,
Pasteurella, and Vibrio spp. The Enterobacteriaceae
vary in their susceptibility, and many strains
have shown acquired resistance, but Escherichia coli,
and strains of Klebsiella spp., Proteus mirabilis, Salmonella,
Shigella, and Yersinia spp. have been reported
to be susceptible. Many strains of Enterobacter, indole-
positive Proteus, and Serratia spp. are resistant,
or at best moderately susceptible. Pseudomonas aeruginosa
is invariably resistant, although Burkholderia
(formerly Pseudomonas) spp. may be susceptible.
Some Gram-negative anaerobes are susceptible, or
moderately so, including Bacteroides fragilis, Veillonella,
and Fusobacterium spp.
Other susceptible organisms include Actinomyces spp.,
Leptospira spp., spirochaetes such as Treponema pallidum,
Chlamydiaceae, Mycoplasma spp., and Rickettsia
spp. Nocardia spp. are resistant. Chloramphenicol
is ineffective against fungi, protozoa, and viruses.
In the treatment of eye infections, chloramphenicol is
usually applied as a 0.5% solution or as a 1% ointment.
Ophth Ocular infections As 0.5% soln: Instill 1 drop 2 hrly, then adjust dosage interval upon
improvement.

Chlortetracycline
Chlortetracycline is a tetracycline derivative with general properties
similar to those of tetracycline (p.347) and is used as the
hydrochloride, more often topically than orally. It is used as a 1%
ophthalmic ointment and as a 3% ointment for application to the
skin
Adult: Ophth Ocular infections As 1% oint: Apply 1 cm to the conjunctiva 2-4 hrly. Topical
Minor skin infections As 3% oint: Apply 1-2 times/day.

Clobetasone
Clobetasone butyrate is also used for inflammatory eye disorders,
as eye drops containing 0.1%. Prolonged use of ophthalmic
preparations containing corticosteroids has caused raised intraocular
pressure and reduced visual function.

Cromoglicate
In allergic conjunctivitis and
vernal keratoconjunctivitis, sodium cromoglicate is
used as drops of 2 or 4%, applied 4 to 6 times daily.

Dexamethasone
For ophthalmic disorders or for topical application in
the treatment of various skin disorders, either dexamethasone
or its esters may be used; concentrations are
often expressed in terms of dexamethasone or dexamethasone
phosphate and are commonly 0.05 to 0.1%
for eye or ear drops and ointments and 0.1% for topical
skin preparations.
Ophth Ocular inflammation As 0.1% susp: Apply 1-2 drops 4-6 times/day, up to hrly admin in
more severe disease. As 0.05% oint: Apply 0.5-1 inch ribbon of oint up to 4 times/day.

epinastine