Professional Information

Dexamethasone / Tobramycin

Pronouncation: (DEX-uh-METH-uh-sone/TOE-bruh-MY-sin)
Class: Steroid antibiotic combination

Trade Names:
TobraDex
- Ointment 0.1% dexamethasone/0.3% tobramycin
- Ophthalmic Suspension 0.1% dexamethasone/0.3% tobramycin

Pharmacology

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Conjunctivitis -- Bacterial	2 comments Rate it!	9.0
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Tobramycin inhibits bacterial protein synthesis, causing death; dexamethasone suppresses inflammatory response.

Indications and Usage

Superficial bacterial ocular infection or risk of bacterial ocular infection; inflammatory conditions of palpebral and bulbar conjunctiva, cornea, and anterior segment of globe where inherent risk of steroid use in certain infective conjunctivitis is accepted to obtain a diminution of edema and inflammation; chronic anterior uveitis and corneal injury from chemical, radiation, thermal burns, or penetration of foreign bodies; risk of superficial ocular infection is high or is an expectation, or potentially dangerous numbers of bacteria will be present in the eye.

Contraindications

Epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, and many other viral diseases of the cornea and conjunctiva; mycobacterial infection of the eye; fungal diseases of ocular structure; hypersensitivity to a component of the product.

Dosage and Administration

Solution
Adults

Ophthalmic Start with 1 or 2 drops instilled into conjunctival sac(s) every 4 to 6 h during first 24 to 48 h; dosage may be increased to 1 or 2 drops every 2 h.

Ointment
Adults and Children 2 yr of age and older

Ophthalmic Apply small amount (approximately 0.5-inch ribbon) into conjunctival sac(s) up to 3 or 4 times daily.

General Advice

Shake suspension well before use.
If using other topical ophthalmic drugs, separate each medication by at least 5 min.

Storage/Stability

Store at controlled room temperature. Keep suspension upright. Keep container tightly closed

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

EENT

Localized ocular toxicity (eg, lid itching, swelling, conjunctival erythema); elevated IOP (with possible glaucoma); infrequent optic nerve damage; posterior subcapsular cataract formation; delayed wound healing; secondary infection (eg, corneal fungal infections); secondary bacterial ocular infection.

Miscellaneous

Hypersensitivity.

Precautions

Pregnancy

Category C .

Lactation

Tobramycin

Undetermined.

Dexamethasone

Excreted in breast milk.

Children

Safety and efficacy not established (solution). Safety and efficacy not established in children younger than 2 yr of age (ointment).

Hypersensitivity

Sensitivity to topically applied aminoglycosides and cross-sensitivity to other aminoglycosides may occur.

Fungal infections

Consider possibility of fungal infections with long-term steroid dosing; prolonged use may result in overgrowth of nonsusceptible organisms, including fungi.

Overdosage

Symptoms

Punctate keratitis, erythema, increased lacrimation, edema, lid itching.

Patient Information

Review prescribed dosing schedule with patient.
Teach patient proper technique for instilling eye drops: Wash hands; do not allow dropper to touch eye. Tilt head back, look up; pull lower eyelid down; instill prescribed number of drops. Close eye for 1 to 2 min and apply gentle pressure to bridge of nose for 3 to 5 min. Do not rub eye.
Teach patient proper technique for instilling ointment: Wash hands; do not allow tip of tube to touch eye. Tilt head back, look up; pull lower eyelid down to form pocket; place prescribed amount of ointment in the pocket. Look downward before closing eye. Do not rub eye.
Advise patient that if more than 1 topical ophthalmic drug is being used, administer the drugs at least 5 min apart.
Inform patient that temporary blurred vision and stinging of the eye are the most common adverse reactions and to contact the health care provider if they occur and are bothersome.
Advise patient to contact the eye doctor if eye or eyelid inflammation is noted, or if eye symptoms worsen or do not improve.
Advise patient that the entire course of therapy must be completed to ensure maximal benefit and to complete full course of therapy even if symptoms have resolved.
Instruct patient not to wear contact lenses during treatment.
Remind patient that follow-up eye examinations may be necessary while using this medication and to keep appointments.