Question

A patient came with a prescription of TobraDex® for a drop into the affected eye, twice daily for a week. TobraDex® is a combination of tobramycin (antibiotic) and dexamethasone (steroid) ophthalmic ointment indicated for steroid-responsive inflammatory ocular condition with a risk of bacterial infection. The patient is concerned if this application could cause any scary steroidal side effects of weakened immune system.

Could the patient experience any weakened immune system side effects if they applied TobraDex^® as according to doctor’s instructions? Please answer based on the systemic absorption route of TobraDex^®.                                         

Answer 1

Corticosteroids may reduce resistance to and aid in the establishment of bacterial, viral, fungal or parasitic infections and mask the clinical signs of infection. The possibility of fungal infections of the cornea should be considered after long-term steroid dosing and in patients with persistent corneal ulceration. As with other antibiotic preparations, prolonged use may result in overgrowth of non- susceptible organisms, including fungi.

If fungal infection occurs, corticosteroids therapy should be discontinued.