A fixed-dose combination ophthalmic preparation containing a broad-spectrum bacteriostatic antibiotic (Chloramphenicol), a potent corticosteroid (Dexamethasone), and a bactericidal polypeptide antibiotic (Polymyxin B). It is primarily indicated for the treatment of severe ocular surface infections where inflammation is a significant component, particularly those involving Gram-negative organisms. The combination provides synergistic antibacterial coverage against a wide range of pathogens while controlling the inflammatory response.
Adult: One drop into the affected eye(s) every 4 to 6 hours. In severe infections, may be used every 2 hours initially, tapering as inflammation subsides. Duration typically 5-10 days; do not exceed without re-evaluation.
Note: 1. Wash hands. 2. Tilt head back. 3. Gently pull lower eyelid to form a pouch. 4. Instill prescribed drops without touching the dropper tip to eye or any surface. 5. Close eyes gently for 1-2 minutes, applying pressure at the inner corner (nasolacrimal occlusion) to minimize systemic absorption. 6. Wait at least 5-10 minutes before instilling any other eye drops.
The combination exerts a triple action: Chloramphenicol inhibits bacterial protein synthesis; Polymyxin B disrupts the bacterial cell membrane, leading to cell death; Dexamethasone suppresses the inflammatory response by inhibiting multiple mediators.
Pregnancy: Category C (US FDA). Corticosteroids and chloramphenicol have shown adverse effects in animal studies. Use only if potential benefit justifies potential fetal risk. Topical use is generally considered low risk, but should be avoided in first trimester unless absolutely necessary.
Driving: May cause temporary blurred vision after instillation. Patients should not drive or operate machinery until vision clears.
| Other topical corticosteroids | Additive risk of IOP elevation and cataract | Moderate |
| Erythromycin, Clindamycin (topical) | Potential antagonism with Chloramphenicol (both bacteriostatic) | Moderate |
| Aminoglycosides (e.g., Gentamicin topical) | Possible chemical/physical incompatibility if mixed; but sequential use for broad coverage is common | Low |
| Oral anticoagulants (Warfarin) | Chloramphenicol may inhibit metabolism, increasing INR and bleeding risk (if systemically absorbed) | Moderate |
| Phenytoin, Phenobarbital | May reduce chloramphenicol levels; dexamethasone metabolism may be induced | Moderate |