The contents of this article are informational only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment recommendations. This editorial presents the views and experiences of the author and does not reflect the opinions or recommendations of the publisher of Ophthalmology 360.
By Blake K. Williamson, MD, MPH, MS
Stocking a fortified antibiotic in the clinic reduces treatment delays and enhances care for potentially sight-threatening infections.
Like most busy, multisite ophthalmology practices, at Williamson Eye Center (WEC), we value any element that enhances the combination of efficacy and efficiency that drives our success. Whether it’s a cutting-edge laser, a new and improved intraocular lens, or an innovative eye drop, we are always eager to expand our armamentarium if it will further the goal of providing the exemplary care that our patients deserve.
A prime example of that strategy is stocking the fortified antibiotic Fortisite™ (ImprimisRx/Harrow) on-site. Fortisite is a topical antibiotic compounded combination of tobramycin 1.5% and vancomycin 5% that is distributed through an ImprimisRx 503B outsourcing facility. Since it became possible to stock Fortisite in WEC’s 8 clinics, when faced with potentially sight-threatening corneal ulcers and other severe corneal infections, we are now able to offer a stronger topical antibiotic with half the preservative load of compounding pharmacy fortified eye drops, and we’re able to provide this treatment without the hassle and delays that notoriously accompany accessing fortified antibiotics from compounding pharmacies.
Expediting Care
Severe corneal infections usually respond well to compounded fortified antibiotics, but the process of obtaining these medications through a compounding pharmacy can introduce significant inefficiencies. Navigating the steps of prior authorization, determining the patient’s proximity to a compounding pharmacy, and arranging timely delivery of the antibiotic can result in critical delays. While these situations aren’t routine, they arise frequently enough that when the opportunity to stock Fortisite on-site became available, we saw it as a practical solution that could greatly enhance patient care.
Imagine it’s 5 o’clock on a Friday, and a patient presents with ocular pain, redness, photophobia, discharge, and decreased vision. The nearest compounding pharmacy is closed for the weekend, and the next option estimates a 36-hour delivery time. Many of our patients face transportation challenges, and the cost of compounded fortified antibiotics can be prohibitive. In cases where a fortified antibiotic is essential, time is critical, and offering a solution that’s geographically or financially out of reach is simply unacceptable. Having advanced fortified antibiotics readily available in the clinic eliminates delays and ensures a win for both the patient and practice.
Aggressive Treatment
Patients with potentially vision-threatening infections are usually triaged by one of our optometry professionals, such as Joshua Davidson, OD, a specialist in contact lenses and corneal diseases. When a patient presents with what appears to be a routine ulcer or abrasion, he begins treatment with a broad-spectrum antibiotic. If there’s no improvement at follow-up in 1 to 2 days, the infiltrate is sent for culture to determine the next steps. In more serious cases, where the ulcer appears concerning from the outset, a culture is taken immediately, and treatment with fortified antibiotics begins. Having Fortisite on hand allows him to treat aggressively with a broad-spectrum fortified antibiotic right away, avoiding delays that could worsen the infection while waiting for delivery from a compounding pharmacy.
Giving patients the benefit of quick access to the tobramycin/vancomycin compound provides us with peace of mind—like an insurance policy—for those rare, but inevitable, severe infections that need prompt treatment. Dr. Davidson suggests that having Fortisite in the clinic is like having a fire extinguisher: We don’t need it often, but when we do, we’re grateful to have immediate access to the right tool.
The Threat of Endophthalmitis
An extremely infrequent, but nonetheless critically important, potential use for Fortisite in a busy ophthalmic surgery practice is for the management of endophthalmitis. While the incidence of endophthalmitis after cataract surgery today is rare, occurring in about 1 in 2,500 cases, it remains a serious complication. If endophthalmitis is suspected, we refer the patient to a retinal specialist for a vitreous tap, culture, and possible injection of intravitreal antibiotics. But given the very real threat to vision that endophthalmitis can pose, we immediately treat with the advanced fortified antibiotic so we’re not wasting a moment even during the brief period before the patient is seen by the retina specialist.
Practical Logistics
For some ophthalmologists, the idea of maintaining a fortified antibiotic in their practice might raise questions around drug potency, sterility, and potential financial losses if the medication expires. These concerns, however, are easily addressed. Fortisite is supplied for in-office use by an FDA-registered 503B outsourcing facility, ensuring that every bottle complies with stringent analytical testing protocols—standards that exceed those of 503A compounding pharmacies. The antibiotic undergoes rigorous potency and sterility testing before being dispensed and remains stable for up to 150 days when refrigerated (5° C). Additionally, ImprimisRx offers a 100% replacement guarantee for any product that expires, which alleviates concerns about waste. This is especially beneficial for high-volume practices like ours, as we can confidently stock Fortisite despite infrequent use, knowing that expired products will be replaced.
Having a potent, fortified antibiotic readily available instills a high level of confidence, particularly in cases where broad-spectrum antibiotics may fall short. Handy access to this preparation offers a crucial “game-changer” in treating challenging infections effectively and efficiently.
Blake K. Williamson, MD, MPH, MS, is President and Managing Partner at Williamson Eye in Baton Rouge, Louisiana, where he specializes in refractive cataract surgery, laser vision correction, and MIGS. He can be reached at [email protected]. Dr. Williamson has no financial interest to report.
Related Content
