Ординатура / Офтальмология / Английские материалы / Drugs in Ophthalmlogy_Fong, Law, Schmidt-Erfurth_2006

Antibiotics

229

resistant in vitro, clinical efficacy has been demonstrated

in urinary tract and gynecologic infections caused by these

organisms); E. coli (beta-lactamase and non-beta-lactamase-

producing); H. influenzae (beta-lactamase and non-beta-lac-

tamase-producing); Klebsiella spp., including K. pneumoniae

(beta-lactamase and non-beta-lactamase-producing); Pseu-

domonas spp., including P. aeruginosa (beta-lactamase and

non-beta-lactamase-producing); S. marcescens (beta-lacta-

mase and non-beta-lactamase-producing). (Note: beta-lac-

tamase-negative ampicillin-resistant (BLNAR) strains of H. in-

fluenzae must be considered resistant to ticarcillin/clavulanic

acid.)

Anaerobic bacteria: B. fragilis group (beta-lactamase and non-

beta-lactamase-producing); Prevotella (formerly Bacteroides)

melaninogenicus (beta-lactamase and non-beta-lactamase-

Indications

producing).

Ocular or periocular infection.

(Ocular Disease)

Topical

6 mg/ml.

Subconjunctival

100 mg/0.5 ml.

Intravenous/Oral

200–300 mg/kg qd, i.v. divided into three doses.

Name

Tobramycin sulfate.

Spectrum

Gram-positive:Staphylococcus spp.

Indications

Gram-negative: especially P. aeruginosa.

Corneal abrasion, keratitis, conjunctivitis.

(Ocular Disease)

Topical

0.3% q.i.d. to q1h.

Subconjunctival

20–40 mg/0.5 ml.

Intravitreal

0.2 mg/0.1 ml.

Intravenous/Oral

3–5 mg/kg qd, i.v. divided into one to three doses.

Name

Vancomycin hydrochloride.

Spectrum

Aerobic gram-positive:S. aureus, including methicillin-resis-

tant strains) associated with enterocolitis.

Anaerobic gram-positive: C. difficile antibiotic-associated

Indications

pseudomembranous colitis.

Infectious cavernous sinus thrombosis (i.v.), open globe (topical

(Ocular Disease)

+ i.v.), endophthalmitis (all routes of administration), keratitis.

Subconjunctival

25 mg/0.5 ml.

Intravitreal

1 mg/0.1 ml.

Intravenous/Oral

1 g i.v., q12h.

Name

Amphotericin B.

Spectrum

Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus,

Indications

Histoplasma, Leishmania, Paracoccidioides.

Aspergillus canaliculitis, Mucormycosis, Fungal keratitis,

(Ocular Disease)

Fungal endophthalmitis.

Topical

0.1–0.25% solution q1h.

Subconjunctival

0.8–1.0 mg.

Intravitreal

0.005 mg/0.1 ml (5 µg).

Intravenous/Oral

0.25–1.0 mg/kg qd divided into four doses.

Name

Fluconazole.

Spectrum

Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus,

Indications

Histoplasma.

Candida endophthalmitis, Candida albicans canaliculitis.

(Ocular Disease)

Intravenous/Oral

400 mg qd in divided doses for 7–10 days.

Name

Flucytosine.

Spectrum

Candida, Cryptococcus.

Indications

Fungal endophthalmitis.

(Ocular Disease)

Topical

1% solution.

Intravenous/Oral

50–150 mg qd divided into four doses.

Name

Itraconazole.

Spectrum

Acanthamoeba, Aspergillus, Blastomyces, Candida, Coccidioi-

des, Cryptococcus, Histoplasma, Paracoccidioides, Sporothrix,

Indications

Trichophyton.

Aspergillus cancaliculitits, Acanthamoeba keratits, Fungal

(Ocular Disease)

endophthalmitis.

Intravenous/Oral

100–200 mg b.i.d.

Name

Ketoconazole.

Spectrum

Acanthamoeba, Blastomyces, Candida, Coccidioides, Crypto-

coccus, Epidermophyton, Histoplasma, Malassezia, Microspo-

Indications

rum, Paracoccidioides, Phialophora, Trichophyton.

Fungal keratitis, Acanthamoeba keratits.

(Ocular Disease)

Intravenous/Oral

200–400 mg qd.

Name

Natamycin.

Spectrum

Aspergillus, Candida, Cephalosporium, Fusarium, Penicillium.

Indications

Fungal keratitis, Fungal blepharoconjunctivitis, Fungal end-

(Ocular Disease)

ophthalmitis.

Topical

5% solution q1h (commercially available).

Antivirals

231

Name

Voriconazole.

Spectrum

Aspergillus, Candida, Fusarium, Scedosporium.

Intravenous/Oral

IV: 6 mg/kg q12h for the first 24 h as loading dose, then 4 mg/

kg i.v. or 200 mg. Oral: q12h as maintenance dose.

Name

Acyclovir sodium.

Spectrum

Herpes simplex virus (HSV), herpes zoster virus (HZV).

Indications

Acute retinal necrosis.

(Ocular Disease)

Intravenous/Oral

IV: 5–10 mg/k qd divided into three doses until resolution,

Indications

then 800 mg. Oral: five times per day for 1–2 months.

(Ocular Disease)

Progressive outer retinal necrosis syndrome.

Intravenous/Oral

IV: 5–10 mg/k qd divided into three doses until resolution,

Indications

then 800 mg. Oral: five times per day for 1–2 months.

Anterior uveitis (HSV).

(Ocular Disease)

Intravenous/Oral

400 mg p.o. five times per day.

Indications

Herpes keratitis.

(Ocular Disease)

Intravenous/Oral

400 mg p.o. five times per day for 10 days.

Indications

Prophylaxis of keratitis recurrence.

(Ocular Disease)

Intravenous/Oral

400 mg p.o. b.i.d. up to 1 year (longer for corneal graft invol-

Indications

vement).

HSV or HZV eyelid involvement.

(Ocular Disease)

Intravenous/Oral

400–800 mg p.o. five times per day for 5–10 days. If immu-

nocompromised, 10–12 mg/kg qd, i.v. in divided into three

Indications

doses for 10–14 days.

Herpes zoster choroiditis, optic neuritis, cranial nerve palsy.

(Ocular Disease)

Intravenous/Oral

5–10 mg/kg i.v., q8h for 1 week.

Name

Cidofovir.

Spectrum

Cytomegalovirus (CMV).

Indications

CMV retinitis.

(Ocular Disease)

Intravenous/Oral

Induction: 5 mg/kg i.v. over 1 hr once weekly for 2 weeks.

Maintenance: 5 mg/kg over 1 hr every 2 weeks.

Name

Famciclovir.

Spectrum

HSV, HZV.

232

Antivirals

Indications

HSV or HZO ophthalmicus (HZO) eyelid involvement.

(Ocular Disease)

Intravenous/Oral

500 mg t.i.d. for 7 days.

Indications

Herpes keratitis (HZO).

(Ocular Disease)

Intravenous/Oral

500 mg t.i.d. for 7 days.

Name

Fomivirsen.

Spectrum

CMV.

Indications

CMV retinitis.

(Ocular Disease)

165–330 µg every week for 3 weeks then every 2 weeks.

Intravitreal

Intravenous/Oral

Induction: 330 µg/0.05 ml i.v. every other week for two doses.

Maintenance: 330 µg/0.05 ml i.v. every 4 weeks.

Name

Foscarnet sodium.

Spectrum

CMV, HSV.

Indications

CMV retinitis.

(Ocular Disease)

Intravitreal

2.4 mg/0.1 ml or 1.2 mg/0.05 ml 2–3 times per week for 2–3

Intravenous/Oral

weeks, then 2.4 mg/0.1 ml 1–2 times per week.

Induction: 90 mg/kg i.v., q12h or 60 mg/kg q8h for 2–3 weeks.

Maintenance: 90–120 mg/kg qd.

Name

Ganciclovir sodium.

Spectrum

CMV.

Indications

CMV retinitis.

(Ocular Disease)

Pellet implantation: release 1 µg/h (lasts 6–8 months). Intra-

Intravitreal

vitreal injection: 200–2,000 µg/0.1 ml two to three injections

Intravenous/Oral

per week for 2–3 weeks, then 200–2,000 µg/0.1 ml per week.

Induction: 5 mg/kg i.v., q12h for 14–21 days. Maintenance:

5 mg/kg qd, i.v. 7 days per week, or 6 mg/kg qd 5 days per

week, or p.o. 1,000 mg t.i.d., or 500 mg for 6 days (q3h). Con-

comitant with intravitreal pellet: 1,000–2,000 mg p.o., t.i.d.

Name

Trifluridine.

Spectrum

HSV.

Indications

HSV blepharoconjunctivitis or keratitis.

(Ocular Disease)

Topical

1% solution every 2 h while awake up to nine times per day

until complete epithelialization of corneal ulcer, then every

4 h while awake for a minimum 5 drops qd for 7 days.

Name

Valacyclovir.

Spectrum

HSV, HZV.

Indications

Acute retinal necrosis.

(Ocular Disease)

Intravenous/Oral

After resolution of retinitis with i.v. acyclovir: 1 g p.o., t.i.d. for

1–2 months.

Antivirals

233

Indications

Herpes keratitis (HZV).

(Ocular Disease)

Intravenous/Oral

1 g p.o., t.i.d. for 7 days.

Indications

(Ocular Disease)

HZV eyelid involvement.

Intravenous/Oral

1 g p.o., t.i.d. for 7 days.

Name

Valganciclovir hydrochloride.

Spectrum

CMV.

Indications

(Ocular Disease)

CMV retinitis.

Intravenous/Oral

Induction: 900 mg p.o. b.i.d. for 21 days. Maintenance: 900 mg

p.o., qd.

Name

Vidarabine (not available in USA).

Spectrum

HSV.

Indications

(Ocular Disease)

HSV blepharoconjunctivitis or keratitis.

Topical

3% solution five times per day for 10–14 days.