Usage
This combination medication is primarily used for the treatment of superficial bacterial eye infections, such as conjunctivitis (pink eye) and blepharitis. It combines the antibacterial action of sulphacetamide with the anti-inflammatory effects of hydrocortisone. Phenyl mercuric nitrate acts as a preservative.
Pharmacological Classification:
- Sulphacetamide: Sulfonamide antibiotic
- Hydrocortisone: Corticosteroid
- Phenyl Mercuric Nitrate: Antiseptic and preservative
Mechanism of Action: Sulphacetamide inhibits bacterial growth by interfering with folic acid synthesis, which is essential for bacterial DNA and RNA production. Hydrocortisone reduces inflammation by suppressing the immune response and inhibiting the production of inflammatory mediators, such as prostaglandins.
Alternate Names
Sulpha FH Eye Drop (This might vary regionally)
How It Works
Pharmacodynamics: Sulphacetamide exerts its antibacterial effect by competitively inhibiting dihydropteroate synthase, a bacterial enzyme crucial for folic acid synthesis. Hydrocortisone, through its glucocorticoid receptor activity, modulates gene expression and influences the function of various immune cells, thus suppressing inflammation.
Pharmacokinetics: Topical application minimizes systemic absorption, but some hydrocortisone can be absorbed systemically. Sulphacetamide is primarily excreted renally.
Dosage
Standard Dosage
Adults: Instill 1-2 drops into the affected eye(s) every 2-3 hours initially. As the infection improves, the frequency can be reduced as directed by the physician. Treatment should continue for at least a week, even if symptoms subside, to ensure complete eradication of the infection.
Children: Dosage in children should be determined by a pediatrician, considering the child’s age and weight. Safety and efficacy in children younger than two years old have not been established.
Special Cases:
- Elderly Patients: No dosage adjustment is typically required, but monitoring for potential systemic side effects of hydrocortisone is advised.
- Patients with Renal Impairment: Caution should be exercised, and dosage adjustment might be necessary in patients with severe renal dysfunction.
- Patients with Hepatic Dysfunction: Close monitoring is recommended, and dosage adjustments may be considered in patients with significant hepatic impairment.
- Patients with Comorbid Conditions: Patients with diabetes, glaucoma, or other ocular conditions should be monitored closely during treatment.
Clinical Use Cases
This medication is specifically for bacterial eye infections and not indicated for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments should be based on patient response and clinical judgment. More frequent instillations may be necessary initially for severe infections.
Side Effects
Common Side Effects
- Transient burning or stinging upon instillation
- Eye irritation or redness
- Blurred vision (immediately after application)
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Increased intraocular pressure (IOP) with prolonged use
- Secondary fungal or viral eye infections
Long-Term Effects
Prolonged use of topical corticosteroids like hydrocortisone can lead to glaucoma, cataracts, or thinning of the cornea.
Adverse Drug Reactions (ADR)
Severe allergic reactions, including anaphylaxis, though rare, necessitate immediate medical attention.
Contraindications
- Hypersensitivity to any component of the medication
- Viral or fungal eye infections (e.g., herpes simplex keratitis, fungal keratitis)
- Untreated purulent eye infections
Drug Interactions
No clinically significant drug interactions are expected with topical application. However, administer other ophthalmic medications at least 5-10 minutes apart.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding has not been definitively established. Consult a physician to assess the benefit-risk ratio.
Drug Profile Summary
- Mechanism of Action: Sulphacetamide inhibits bacterial folic acid synthesis; hydrocortisone suppresses inflammation.
- Side Effects: Burning/stinging, eye irritation, blurred vision (common); allergic reactions, increased IOP, secondary infections (rare).
- Contraindications: Hypersensitivity, viral/fungal eye infections, untreated purulent infections.
- Drug Interactions: No significant interactions expected.
- Pregnancy & Breastfeeding: Safety not established.
- Dosage: 1-2 drops every 2-3 hours initially, then taper as directed.
- Monitoring Parameters: Monitor for allergic reactions, IOP, and resolution of infection.
Popular Combinations
This combination itself is a common formulation, and further combinations are generally not recommended. Always consult an ophthalmologist before combining any eye medications.
Precautions
- General Precautions: Screen for allergies and assess ocular health before initiating treatment.
- Specific Populations: Consult a physician for pregnant/breastfeeding women. Pediatric dosing should be determined by a pediatrician. Monitor elderly patients for systemic effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Hydrocortisone + Phenyl Mercuric Nitrate + Sulphacetamide?
A: Adults: 1-2 drops in the affected eye(s) every 2-3 hours initially, reducing frequency as infection improves. Pediatric dosage: consult a pediatrician.
Q2: What are the common side effects?
A: Burning or stinging, eye irritation, redness, and transient blurred vision.
Q3: Can this medication be used for viral eye infections?
A: No, it is contraindicated in viral or fungal eye infections.
Q4: What should patients do if they experience an allergic reaction?
A: Discontinue use immediately and seek medical attention.
Q5: Can pregnant or breastfeeding women use this medication?
A: Safety hasn’t been established; consult a physician.
Q6: Are there any drug interactions I should be aware of?
A: No significant drug interactions are expected with topical application. Space out other ophthalmic medications by 5-10 minutes.
A: Generally, avoid wearing contact lenses during treatment for bacterial eye infections. Consult your ophthalmologist.
Q8: How long should the treatment continue?
A: For at least a week, even if symptoms resolve earlier, to ensure complete eradication of the infection.
Q9: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember, unless it is almost time for the next dose. Do not double the dose.
