Polymyxin B + Bacitracin
Place in Therapy
Place in Therapy
Polymyxin B 10000 units in combination with bacitracin 500 units is applied topically, to the affected eye(s), four times daily for seven to 10 days (1, 2, 3, 4). Both polymyxin B and bacitracin are antibiotics, which inhibit the cell wall synthesis thereby killing the bacteria; polymyxin B has activity against gram negative bacteria, whereas bacitracin has activity against gram positive bacteria (5). As a combination therapy, these antibiotics have greater susceptibility (93%) against common pathogens that cause bacterial conjunctivitis (e.g. Streptococcus pneumoniae and Haemophilus influenzae) compared to each antibiotic alone (5).
Studies determining the effect of topical antibiotics on bacterial conjunctivitis have demonstrated beneficial effects of a variety of antibiotics and do not indicate a first line antibiotic product (5, 6). Due to the high susceptibility to common pathogens and the over the counter availability of polymyxin B/bacitracin, the product is a suitable choice for the treatment of bacterial conjunctivitis (5). Compared to polymyxin B/gramicidin eye drops, polymyxin B/bacitracin has more evidence for the clinical benefit in bacterial conjunctivitis, including a randomized placebo-controlled trial (2). Similarly, polymyxin B/bacitracin has been recommended for the use in children due to the ease of administration (1). The use of polymyxin B/bacitracin has been studied in children one month and older with proven benefit and no documented safety concerns and therefore should be considered a first line agent (2, 6, 7).
References
1. Anti-infective Review Panel. Anti-infective Guidelines for Community-acquired Infections. Toronto: MUMS Guideline Clearinghouse; 2012: 2-4.
2. Gigliotti F, Hendley JO, Morgan J, Michaels R, Dickens M, Lohr J. Efficacy of Topical Antibiotic Therapy in Acute Conjunctivitis in Children. J Pediatr. 1984; 104: 623-626.
3. Ang A, Bouchard P, Champagne MC, Hildebrand M, Kim JH, Lampron AM et al. The Practical Guide to Non-prescription Drugs, 2nd Edition. Edipharm, Quebec. 2008: 169-170, 172, 174.
4. Lexicomp Online, Bacitracin and Polymyxin B Lexi-Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 2014; http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6410 Accessed 01 March 2014.
5. Robert PY, Adenis JP. Comparative Review of Topical Ophthalmic Antibacterial Preparations. Drugs. 2001; 61 (2): 175-185.
6. Sheikh A, Hurwitz B, van Schayck CP,McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD001211.
7. Golde KT, Gardiner MF. Bacterial Conjunctivitis in Children: A Current Review of Pathogens and Treatment. International Ophthalmology Clinics. 2011; 51(4): 85-92.
Polymyxin B 10000 units in combination with bacitracin 500 units is applied topically, to the affected eye(s), four times daily for seven to 10 days (1, 2, 3, 4). Both polymyxin B and bacitracin are antibiotics, which inhibit the cell wall synthesis thereby killing the bacteria; polymyxin B has activity against gram negative bacteria, whereas bacitracin has activity against gram positive bacteria (5). As a combination therapy, these antibiotics have greater susceptibility (93%) against common pathogens that cause bacterial conjunctivitis (e.g. Streptococcus pneumoniae and Haemophilus influenzae) compared to each antibiotic alone (5).
Studies determining the effect of topical antibiotics on bacterial conjunctivitis have demonstrated beneficial effects of a variety of antibiotics and do not indicate a first line antibiotic product (5, 6). Due to the high susceptibility to common pathogens and the over the counter availability of polymyxin B/bacitracin, the product is a suitable choice for the treatment of bacterial conjunctivitis (5). Compared to polymyxin B/gramicidin eye drops, polymyxin B/bacitracin has more evidence for the clinical benefit in bacterial conjunctivitis, including a randomized placebo-controlled trial (2). Similarly, polymyxin B/bacitracin has been recommended for the use in children due to the ease of administration (1). The use of polymyxin B/bacitracin has been studied in children one month and older with proven benefit and no documented safety concerns and therefore should be considered a first line agent (2, 6, 7).
References
1. Anti-infective Review Panel. Anti-infective Guidelines for Community-acquired Infections. Toronto: MUMS Guideline Clearinghouse; 2012: 2-4.
2. Gigliotti F, Hendley JO, Morgan J, Michaels R, Dickens M, Lohr J. Efficacy of Topical Antibiotic Therapy in Acute Conjunctivitis in Children. J Pediatr. 1984; 104: 623-626.
3. Ang A, Bouchard P, Champagne MC, Hildebrand M, Kim JH, Lampron AM et al. The Practical Guide to Non-prescription Drugs, 2nd Edition. Edipharm, Quebec. 2008: 169-170, 172, 174.
4. Lexicomp Online, Bacitracin and Polymyxin B Lexi-Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 2014; http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6410 Accessed 01 March 2014.
5. Robert PY, Adenis JP. Comparative Review of Topical Ophthalmic Antibacterial Preparations. Drugs. 2001; 61 (2): 175-185.
6. Sheikh A, Hurwitz B, van Schayck CP,McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD001211.
7. Golde KT, Gardiner MF. Bacterial Conjunctivitis in Children: A Current Review of Pathogens and Treatment. International Ophthalmology Clinics. 2011; 51(4): 85-92.