1. 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

2. Purpose Fortification – dictionary meaning
the act, art, or science of fortifying or strengthening
Fortification of antibiotics may be required
To achieve the MIC levels for pathogens which may be difficult with the usual 0.3% / usual strength topical antibiotics
Drug resistant cases
In large and severe ulcers
Drug is available in parenteral form and not as topical drops

3. Drawbacks of fortification
Gokhale NS. Ind J Ophthalmol

4. 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

5. Fortified Aminoglycosides
Fortified Rx
ADD
Final Concentration
Storage
Shelf life
Tobramycin
(1.4%)
Tobramycin 0.3% eye drop
- 15mg in 5 ml
Inj. Tobramycin-2ml/80mg
95 mg in 7 ml – 1.4%
4deg C
1 week in Fridge
4 days in room temperature
Gentamycin
Gentamicin 0.3%
eye drop
Inj. Gentamicin-2ml/80mg
Gentamicin
95 mg in 7 ml - 1.4%

6. Fortified Aminoglycosides
Fortified Rx
Add
Final concentration
Temperature
Stability
Amikacin 2.5%
Inj Amikacin
250mg/2ml
8ml artificial tears
Amikacin
250mg/10ml –
2.5%
4deg C
7 days

7. Fortified Cephalosporins
Drug
ADD
Fortified Cefazolin 5%
Inj. Cefazolin – 5oomg
10 ML artificial tears
500mg in 10 ml – 5%
Fortified Cefazolin
4 deg C
1 week
Fortified Ceftazidime 5%
Inj Ceftazidime 500mg
Fortified Ceftazidime

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Thank you