2 years or older:
-Suspension: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) up to 4 to 6 times a day; in severe disease, may be used hourly and tapered to discontinuation as inflammation subsides
-A maximum of 20 mL of suspension should be prescribed initially and should not be refilled without further evaluation of the patient's condition.
-If signs/symptoms fail to improve after 2 days of treatment, the patient should be re-evaluated.
-For the treatment of steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where bacterial infection or risk of bacterial ocular infection exists
-Ocular corticosteroids are indicated in inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe where the inherent risk of corticosteroid use in certain infective conjunctivitides is accepted to obtain a diminution in edema and inflammation; also indicated in chronic anterior uveitis and corneal injury from chemical, radiation, or thermal burns; or penetration of foreign bodies
-The anti-infective component of this drug is active against the following common bacterial eye pathogens: Staphylococcus aureus, Escherichia coli, Haemophilus influenzae, Klebsiella/Enterobacter species, Neisseria species, and Pseudomonas aeruginosa; this drug does not provide adequate coverage against Serratia marcescens and Streptococci including S pneumoniae
Dexamethasone; neomycin; polymyxin B is indicated for the treatment of inflammatory ocular conditions where a risk of superficial bacterial infection exists. Together neomycin and polymyxin B displays activity against Enterobacter species, Escherichia coli, Haemophilus influenzae, Klebsiella species, Neisseria species, Pseudomonas aeruginosa, and Staphylococcus aureus. Clinicians may wish to consult the individual monographs for more information about each component.
Neomycin: Neomycin is bacteriocidal. It is actively transported into the bacterial cell where it binds to receptors present on the 30S ribosomal subunit of susceptible bacteria. This binding interferes with the initiation complex between the messenger RNA (mRNA) and the subunit. As a result, abnormal, nonfunctional proteins are formed due to misreading of the bacterial mRNA. Eventually, susceptible bacteria die because of the lack of functional proteins.
Polymyxin B: Polymyxin B binds to gram-negative bacterial cell membrane phospholipids. This binding destroys bacterial membranes with a surface detergent-like mechanism and increases the permeability of the cell membrane, which results in loss of metabolites essential to bacterial existence. Polymyxin B is bactericidal against most gram-negative bacilli. Polymyxin B has no in vitro activity against gram-positive organisms.
Dexamethasone: Dexamethasone is a corticosteroid with anti-inflammatory action. Corticosteroids are naturally occurring hormones that bind to specific protein receptors on targeted tissues. This binding induces a response by modifying transcription and, ultimately, protein synthesis to achieve the steroid's intended action. The anti-inflammatory action of dexamethasone results from the inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of inflammatory response, and suppression of humoral immune responses. The end result of treatment with dexamethasone includes reduction in edema or scar tissue as well as a general suppression of the immune response.