Usage
Hydrocortisone + Tetracycline is primarily prescribed for bacterial eye infections, often accompanied by inflammation. It combines an antibiotic (tetracycline) with an anti-inflammatory corticosteroid (hydrocortisone).
Pharmacological Classification:
- Tetracycline: Antibiotic
- Hydrocortisone: Corticosteroid, anti-inflammatory, glucocorticoid
Mechanism of Action:
Tetracycline inhibits bacterial protein synthesis, thus halting bacterial growth. Hydrocortisone reduces inflammation by suppressing the immune response and inhibiting prostaglandin synthesis.
Alternate Names
While “Hydrocortisone + Tetracycline” represents the generic combination, regional or international variations may exist. Brand names include Terra-Cortril (containing oxytetracycline, a tetracycline analog) and Netracortil.
How It Works
Pharmacodynamics: Tetracycline exerts a bacteriostatic effect by binding to the 30S ribosomal subunit of susceptible bacteria, preventing aminoacyl-tRNA from binding and blocking protein synthesis. Hydrocortisone binds to glucocorticoid receptors, modulating gene expression and affecting various metabolic and immune processes. This leads to decreased inflammation, reduced capillary permeability, and suppressed immune cell activity.
Pharmacokinetics:
- Absorption: Topical ocular application leads to minimal systemic absorption of both drugs.
- Metabolism: Hepatic metabolism for both, though minimally relevant given limited systemic absorption from ocular use.
- Elimination: Renal excretion (tetracycline), primarily, with some biliary excretion (hydrocortisone). The minimal systemic absorption after ophthalmic use makes these pathways less critical for this route of administration.
Mode of Action: Described above in Pharmacodynamics.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: Tetracycline primarily affects bacterial ribosomal function. Hydrocortisone binds to glucocorticoid receptors.
Dosage
Standard Dosage
Adults:
Terra-Cortril ophthalmic ointment: Apply a small amount (approximately 1 cm) to the affected eye two or three times daily. Terra-Cortril ophthalmic suspension: Instill 1 or 2 drops into the affected eye three times daily.
Children:
Not recommended for children under 8 years old. Specific pediatric dosing should be determined by a physician.
Special Cases:
- Elderly Patients: No specific dosage adjustments are generally recommended. However, close monitoring is advisable.
- Patients with Renal Impairment: No specific adjustments for topical ophthalmic use, given minimal systemic absorption. Systemic tetracycline may require dose adjustments in renal impairment.
- Patients with Hepatic Dysfunction: No specific adjustments for topical ophthalmic use, given minimal systemic absorption. Systemic tetracycline may require dose adjustments in hepatic impairment.
- Patients with Comorbid Conditions: Exercise caution and individualize treatment.
Clinical Use Cases
The dosages for clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations are the same as standard dosages mentioned earlier.
Dosage Adjustments
Dosage adjustments should be based on individual patient response and clinical judgment.
Side Effects
Common Side Effects
Blurred vision, increased tear production, temporary stinging or burning sensation in the eye, foreign body sensation, eye irritation, eye redness, sensitivity to light, changes in taste.
Rare but Serious Side Effects
Allergic reactions, glaucoma, optic nerve damage, posterior subcapsular cataract formation, secondary infections (fungal or bacterial).
Long-Term Effects
Chronic use of topical corticosteroids can lead to glaucoma, cataracts, and impaired wound healing.
Adverse Drug Reactions (ADR)
Severe allergic reactions, severe eye pain, sudden vision changes.
Contraindications
Hypersensitivity to any component, herpes simplex keratitis, vaccinia, varicella, viral conjunctivitis or otic infections, mycobacterial eye infections, fungal eye or ear infections, acute purulent eye infections, corneal ulceration, corneal abrasions or lacerations, perforated eardrum.
Drug Interactions
Tetracycline can interact with certain medications, including some antacids, anticoagulants, and oral contraceptives. Hydrocortisone can interact with some antifungal medications and NSAIDs. Topical ophthalmic use minimizes the risk of systemic interactions. However, always consider concurrent medications. For instance, oral tetracycline can interact with guaifenesin and rifampicin.
Pregnancy and Breastfeeding
Topical use is generally considered safe during pregnancy and breastfeeding due to limited systemic absorption. However, it’s best to consult with a physician.
Drug Profile Summary
- Mechanism of Action: Tetracycline inhibits bacterial protein synthesis; hydrocortisone suppresses inflammation.
- Side Effects: Ocular irritation, blurred vision, increased tearing; rarely glaucoma, cataracts.
- Contraindications: Hypersensitivity, viral/fungal eye infections, corneal damage.
- Drug Interactions: Potential with certain oral medications, minimal with topical ophthalmic use.
- Pregnancy & Breastfeeding: Generally safe topically due to limited systemic absorption.
- Dosage: Adults: Ointment 1cm, 2–3 times/day; Suspension 1–2 drops, 3 times/day.
- Monitoring Parameters: Intraocular pressure, signs of infection, allergic reaction.
Popular Combinations
Hydrocortisone is often combined with tetracycline or other antibiotics for ophthalmic use.
Precautions
Thorough eye examination before starting therapy is essential. Monitor for secondary infections. Do not use for extended periods without medical supervision. Avoid touching the eye with the applicator tip. Discontinue if irritation persists or worsens. Caution in patients with glaucoma.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Hydrocortisone + Tetracycline ophthalmic preparations?
A: Adults: Ointment: Apply a small amount (approximately 1 cm) 2–3 times/day. Suspension: Instill 1–2 drops 3 times/day. Pediatric dosing should be determined by a physician.
Q2: What are the common side effects of Hydrocortisone + Tetracycline eye preparations?
A: Blurred vision, stinging, burning, increased tearing, foreign body sensation.
Q3: Can Hydrocortisone + Tetracycline eye preparations be used during pregnancy or breastfeeding?
A: Topical use is generally considered safe due to limited systemic absorption, but consult a doctor.
Q4: Who should not use Hydrocortisone + Tetracycline ophthalmic preparations?
A: Patients with hypersensitivity, viral or fungal eye infections, corneal ulceration, or a perforated eardrum.
Q5: How long can Hydrocortisone + Tetracycline eye preparations be used?
A: Generally, not longer than 7 days without medical supervision.
Q6: What should I do if my symptoms don’t improve after using Hydrocortisone + Tetracycline?
A: Consult your doctor immediately.
A: Remove contact lenses before application and wait at least 15 minutes before reinserting.
Q8: What are the signs of an allergic reaction to Hydrocortisone + Tetracycline eye preparations?
A: Severe itching, swelling, redness, or difficulty breathing. Seek medical attention immediately.
Q9: How should Hydrocortisone + Tetracycline ophthalmic preparations be stored?
A: Store below 25°C.
