Abstract

Vancomycin is the drug of choice for methicillin-resistant Staphylococcus aureus keratitis and other ocular infections. Vancomycin ophthalmic drops are not commercially available and require compounding. The present study was designed to investigate the stability of vancomycin ophthalmic drops in normal saline, phosphate-buffered saline (PBS), and balanced salt solution (BSS) while stored at room temperature or under refrigeration. Vancomycin ophthalmic drops (50 mg/mL) were aseptically prepared from commercially available intravenous powder using PBS, BSS, and saline. Solutions were stored at room temperature and in a refrigerator for 28 days. The vancomycin stability was tested by a microbiology assay and high-performance liquid chromatography HPLC analysis immediately after formulation and at days 7, 14, and 28 after storage at room temperature or under refrigeration. The pH, turbidity was also tested. Vancomycin formulations in PBS, BSS and normal saline had initial pH of 5; 5.5; 3 respectively. The formulation in PBS developed turbidity and a slight decrease in pH upon storage. Microbiological assay did not show any change in zone of inhibition with any of the formulation upon storage either at room temperature or under refrigeration. HPLC analysis did not detect any decrease in vancomycin concentration or the accumulation of degraded products in any of the formulations upon storage either at room temperature or under refrigeration. Vancomycin ophthalmic drops prepared using PBS, BSS, and normal saline were stable up to the tested time point of 28 days, irrespective of their storage temperature.

Highlights

  • Keratitis is an infection of the cornea caused by bacteria, fungi, herpes virus, or acanthamoeba

  • The incidence of Methicillin-resistant S. aureus (MRSA) ocular infections in the United States has been rising in recent years, with multiple studies reporting that MRSA accounts for roughly 30–40% of all S. aureus cases of keratitis [16,17,18]

  • Vancomycin formulated in phosphate-buffered saline (PBS) and stored at room temperature or under refrigeration remained clear for 14 days after preparation, but subsequently, it developed visible turbidity under both the storage conditions

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Summary

Introduction

Keratitis is an infection of the cornea caused by bacteria, fungi, herpes virus, or acanthamoeba. It is a sight-threatening medical emergency requiring prompt and effective intervention. Staphylococcus aureus is the second most common pathogen causing bacterial keratitis, the exact incidence of infection varies by geographic location [1,2]. MRSA is known to cause a variety of ocular infections, including keratitis [13,14,15]. The incidence of MRSA ocular infections in the United States has been rising in recent years, with multiple studies reporting that MRSA accounts for roughly 30–40% of all S. aureus cases of keratitis [16,17,18]

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