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TOPICAL OPHTHALMIC ANTIBIOTICS Fortified Ancef Ophthalmic Solution (50 mg/cc) Add 9.2 cc of Tears Naturale to 1.

0 gram of Ancef - Dissolve Take 5.0 cc of this solution and add it to 5.0 cc of Tears Naturale LABEL: Ancef (50 mg/cc) Refrigerate Discard after 7 days Amphotericin B Topical Solution (0.15 mg/cc) Take 50 mg vial and add 10cc nonpreserved water for injectable use (Solution #1) Take 9.0 cc of Solution #1 and add 21.0 cc of nonpreserved water for injectable use. LABEL: Amphotericin (0.15 mg/cc) Refrigerate Protect from Light Discard after 7 days Amikacin Ophthalmic Solution (8 mg/cc) Withdraw 0.48 cc of Amikacin (500mg/2ml) Add the 0.48 to 15 cc of sterile non preserved water LABEL: Amikacin Solution (8mg/cc) Discard after 7 days Carbenicillin Ophthalmic Solution (4mg/cc) Add 3.6 cc of Tears Naturale to 1.0 gram of carbenicillin. Dissolve Add 0.176 of resulting solution to 11 cc of Tears Naturale solution LABEL: Carbenicillin (4mg/cc) Refrigerate Discard after 7 days

Ceftazidime (Fortaz) Ophthalmic Drops (50mg/cc) Add 4.6 cc of Tears Naturale to a vial of Ceftazidime 500mg. Dissolve Take 5.0 cc of this solution and add it to 5 cc of Tears Naturale. LABEL: Fortaz Ophthalmic Solution 50mg/ml. Discard after 7 days. Refrigerate. Clindamycin Ophthalmic Solution (50 mg/cc) Add 3.3 cc of Clindamycin Phosphate injection (600mg/4cc) to 6.7 cc of Tears Naturale (or any artificial tear preparation). LABEL: Clindamycin (50 mg/cc) Refrigerate Discard after 7 days Fortified Gentamicin Solution (9.0 mg/cc) Withdraw 1.0 cc of gentamicin injectable (80mg/2cc) Add the 1.0 cc to a gentamicin ophthalmic solution (5.0 cc) LABEL: Gentamicin Fortified Solution (9.0 mg/cc) Discard after 30 days

Methylprednisonlone Solution 1% Dilute 1 vial of Solu-Medrol 125mg/2ml Withdraw 6.6 ml from a 15 cc bottle of BSS Inject 1.6 cc of solumedrol into BSS bottle LABEL: Methylprednisolone 1% ophthalmic solution. Keep in amber bottle. Expiration 3 days --------------------------------------Penicillin G Potassium Ophthalmic Solution (100,000 U/ml) Add 9.6 ml Tears Naturale to 1,000,000 U Penicillin G. Potassium. Dissolve Remove remainder of Tears Naturale from original containers. Transfer Penicillin solution to Tears Naturale container. LABEL: Penicillin G 100,000 U/ml Discard after 7 days Ticarcillin Ophthalmic Solution (4mg/cc) Add 10.8 cc of Tears Naturale to a 3.0 gram vial of Ticarcillin. Dissolve Add 0.176 cc of resulting solution to 11 cc of Tears Naturale solution. LABEL: Ticarcillin Ophthalmic Solution (4.0 mg/cc) Refrigerate Discard after 7 days 3 Ophthalmic Solution (50 mg/cc) Dilute a 500 mg vial of Vancomycin with 10.0 cc of Tears Naturale. Dissolve Place in an empty Tears Naturale bottle LABEL: Vancomycin Ophthalmic Drops (50 mg/cc) Discard after 7 days --------------------------------------SUBCONJUNCTIVAL ANTIBIOTICS

ANTIBIOTICS

AMOUNT IN PACKAGE 500mg/2ml 1.0 gram 50,000 units 1.0 gram

VOLUME ADDED* 0 5 ml 5 ml 5 ml

VOLUME FOR INJECTION 0.4ml 0.5ml 0.5ml 0.5 ml

DOSE

Amikacin Ampicillin Bacitracin Carbenicillin

100 mg 100 mg 5000 units 100 mg

Keflex Cephaloridine Cefazolin Chloramphenicol Colistin Gentamicin Methicillin Neomycin Penicillin Vancomycin

1.0 gram 1.0 gram 500 mg 1.0 gram 150 mg 80mg/2ml 1.0 gram 500 mg 5,000,000 units 500 mg

5 ml 5 ml 2.5 ml 5.0 ml 2.0 ml 0 5.0 ml 1.0 ml 3.0 ml 5.0 ml

0.5 ml 0.5 ml 0.5 ml 0.5 ml 0.3 ml 0.5 ml 0.5 ml 0.5 ml 0.5 ml 0.25 ml

100 mg 100 mg 100 mg 100 mg 25 mg 20 mg 100 mg 250 mg 500,000 units 25 mg

*NOTE: ALL DILUTIONS SHOULD BE MADE WITH NON-BACTERIOSTATIC STERILE WATER

--------------------------------------INTRAVITREAL ANTIBIOTICS* Amphotericin B Intravitreal Injection (0/005mg/0.1cc) Take 50 mg vial and add 10 cc of non preserved normal saline. Take 0.1cc of this solution and add 9.9cc of non preserved normal saline. Final concentration: 0.005mg/0.1cc Protect from light Amikacin Intravitreal Injection (400mcg/0.1cc) Take 0.8cc of Amikacin (500 mg/2ml) Add 9.2 cc of NaCl non bacteriostatic to make 10 cc containing 200 mg of amikacin (Solution #1) Take 0.2 cc of Solution #1 (4.0 mg) and Add 0.8 cc of NaCl non bacteriostatic to make 1.0 cc containing 4.0 mg = 4000 mcg INJECT 0.1cc of solution = 0.4mg = 400 mcg

Cefazolin Intravitreal Injection (2.25 mg/0.1cc) To 500 mg vial of Cefazolin add 2.0 cc of sterile nonpreserved normal saline. Take 1.0 cc of this solution and dilute with 9.0 cc of normal saline giving 10.0 cc of total volume. Final concentration = 2.25 mg/0.1cc INJECT 0.1 cc of solution = 2.25 mg Ceftazidime (Fortaz) Intravitreal Injection (2.25 mg/0.1cc) Utilize FORTAZ no other formulation. To 500 mg vial of Ceftazidime add 2.0 cc of sterile nonpreserved normal saline. Take 1.0 cc of this solution and dilute with 9.0 cc of normal saline giving 10.0 cc of total volume. Final concentration = 2.25 mg/0.1cc. INJECT 0.1 cc of solution = 2.25 mg

Decadron Intravitreal Injection (100 mcg/0.1cc) Withdraw 1.0 cc of Decadron (MSD brand only) 4.0mg/cc Withdraw 3.0 cc of Normal Saline without preservatives Final concentration is 4.0 mg/4.0 cc (1.0 mg/1.0cc) INJECT 0.1cc of solution = 0.1 mg = 100 mcg Gentamicin Intravitreal Injection (100mcg/0.1cc) Take 0.1cc from vial of 80mg/2cc of gentamicin injection Dilute with 3.9 cc of nonpreserved normal saline giving 4.0 mg/4cc INJECT 0.1 cc of solution = 0.1 mg = 100 mcg Vancomycin Intravitreal Injection (1.0mg/0.1cc) Dilute 500 mg vial of vancomycin with 10cc of nonperserved 0.9% NaCl Withdrawl 2.0 cc of this solution and dilute up to 10 cc with 0.9% NaCl (add 8.0 cc of 0.9% NaCl). INJECT 0.1 cc of solution = 1.0 mg = 1000 mcg

Mutamycin 0.4mg/ml for Topical Intraocular Use Vertical flow hood using aseptic technique Reconstitute 5 mg vial mutamycin with 12.5 cc of sterile water for injection. Resulting solution is 0.4mg/ml Transfer 0.5 cc into TB syring and cap off. Makes approximately 20 syringes Freeze and maintin storage at 10 degree F or lower. Syringes frozen have a 90 day expiration. When dispensed to ASC label for 24 hours expiration keep in refrigerator.

* All preparations should be made under sterile hood with millipore filters. All concentrations should be confirmed by pharmacist making preparation. More than needed volume should be sent to operating room to allow for sterile transfer. To increase accuracy, inject from TB syringe from one volume to another eliminating error caused by fluid in needle hub. For example, inject from 0.3 cc to 0.2 cc. Use extreme caution not to confuse with subconjunctival antibiotics which made have also been made up for case (will be much higher concentration and usually injecting 0.5cc).