Background and importance Corneal ulcers are a common problem that may appear more frequently in patients with inappropriate use of contact lenses. Unfortunately, it can be difficult to diagnose; its cause can be elusive and the consequences of an error in diagnosis or treatment can be severe.
Aim and objectives To describe the development of 0.5% imipenem–cilastatin eye drops and to evaluate the effectiveness and safety of this master formula.
Material and methods In February 2019, a 41-year-old woman presented to the emergency department for severe pain in the right eye. Commercial eye drops (0.3% tobramycin and 0.5% moxifloxacin) were being applied. The ophthalmology department diagnosed an infiltrated corneal ulcer with an epithelial defect. Microbiological culture of the contact lenses was requested and Enterococcus faecalis and Achromobacter xylosoxidans were isolated. The antibiogram revealed sensitivity to β-lactams and resistance to tobramycin and quinolones. The ophthalmologist contacted the pharmacy service to select the most appropriate treatment, deciding on the development of 5% ceftazidime and 0.5% imipenem fortified eye drops (1 drop every 2 hours). A corneal scraping was also carried out where growth of Fusarium spp was found. Therefore, therapy was completed with 1% voriconazole (1 drop every 2 hours) and 5% natamycin (1 drop every 4 hours).
A bibliographic search was made in PubMed and in the Spanish Society of Hospital Pharmacy, focusing on organoleptic characteristics, stability and pH. Effectiveness and safety were evaluated in the medical history (Selene).
Results We manufactured 5 mg/mL imipenem–cilastatin eye drops from the vial for intravenous use and water for injection, working in a horizontal laminar flow cabinet and following the standardised work procedure. A 0.22 µm filter was used. We established stability at 2–8°C for 2 days, protected from light. It was verified that a completely transparent liquid with pH 7 had been obtained.
Conclusion and relevance Imipenem–cilastatin 0.5% eye drops proved to be a novel alternative in the treatment of corneal ulcers caused by Enterococcus faecalis and Achromobacter xylosoxidans. It produced a rapid and intense antibiotic effect that resulted in a reduction in eye inflammation. It was also easy to apply, which facilitated therapeutic compliance and contributed to a shorter hospital stay. Its safety and tolerance profiles were adequate.
References and/or acknowledgements No conflict of interest.
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