Vancomycin 25 mg/mL ophthalmic solution is a compounded, prescription antibiotic eye drop. It is a "fortified" preparation, meaning it is made at a higher, stronger concentration than any standard commercial eye drop. Vancomycin is an antibiotic that works against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It is prepared by a licensed pharmacy as a sterile eye drop and is used under the care of an eye specialist to treat serious bacterial eye infections.
Because there is no FDA-approved vancomycin eye drop in the United States, providers prescribe it off-label and rely on a compounding pharmacy to prepare it. Only a licensed provider can decide whether it is appropriate, and it is typically prescribed and monitored by an eye specialist.
How does it work?
Vancomycin is a glycopeptide antibiotic. It kills bacteria by blocking the building of their cell wall, and it is especially active against gram-positive bacteria, including MRSA and other staphylococci and streptococci (StatPearls, Vancomycin). Applied directly to the eye as a fortified (high-concentration) drop, it delivers the antibiotic to the surface tissue where a serious infection is present. Your eye specialist sets the concentration, schedule, and length of treatment, often based on cultures of the infection.
What is it used for?
Fortified vancomycin eye drops are used to treat serious bacterial eye infections caused, or suspected to be caused, by gram-positive bacteria such as MRSA. The most common use is bacterial keratitis, an infection of the cornea (sometimes called a corneal ulcer); it is also used for other bacterial surface infections and as part of treatment for more severe infections. It is frequently prescribed together with a second fortified antibiotic to cover a broader range of bacteria until cultures return (EyeWiki, Bacterial Keratitis). It is used off-label because there is no FDA-approved vancomycin eye drop in the United States. Only a licensed provider can decide whether it is appropriate; Bayview Pharmacy does not provide consultations or determine appropriateness, and a valid prescription is required.
How is it used?
Use it exactly as your eye specialist directs. Because these are serious infections, the drops are often used very frequently at first, for example one drop in the affected eye every hour or every two hours while awake, and then tapered as the infection improves; some plans use it four times a day. Wash your hands before use, and do not let the dropper tip touch the eye or any surface. If you use more than one eye drop, ask how many minutes to wait between them. Keep every follow-up appointment so your specialist can check that the infection is responding, and do not stop early even if the eye feels better. A Bayview pharmacist is available if you have questions about your prescription.
Side effects & safety
The most common effects are local, such as stinging or burning when the drop goes in, eye redness or irritation, and temporary blurred vision. Because the drops are strong and are often used very frequently, they can sometimes irritate the surface of the eye; your specialist weighs this against treating the infection. Allergic reactions are possible.
Who should not use it?
Vancomycin eye drops are not appropriate for everyone. They should not be used by anyone with a known allergy to vancomycin or to any ingredient in the preparation. Tell your provider about the full health history, allergies, contact-lens use, and all medications of the person who will use it. Contact lenses are generally not worn during treatment of an eye infection unless your specialist directs otherwise.
How should it be stored?
Store exactly as directed on your label. Fortified vancomycin drops are kept refrigerated and have a short beyond-use date because the medication is only stable for a limited time, so follow your label closely and do not use the drops past the date given. Keep the bottle tightly closed and out of the reach of children, do not share it, and do not touch the dropper tip to the eye or any surface. Dispose of unused medication as directed, and ask your pharmacist if you need a fresh supply to complete your course.
Why is this compounded?
There is no FDA-approved vancomycin eye drop in the United States, and the fortified (high) concentration needed to treat a serious eye infection is not available as a commercial product. Compounding lets a licensed pharmacy prepare vancomycin as a sterile eye drop at the concentration a specialist orders, such as 25 mg/mL. As a 503A compounding pharmacy, Bayview Pharmacy prepares each order as a sterile ophthalmic preparation in small batches under USP <797> standards using quality ingredients. Compounded preparations are not FDA-approved.
Clinical details for prescribers
Regulatory status. Vancomycin is not a controlled substance. There is no FDA-approved ophthalmic vancomycin product in the United States; the fortified ophthalmic form is compounded and prescribed off-label. Compounded preparations are not FDA-approved.
Formulation & SIG. Compounded sterile fortified ophthalmic solution, vancomycin 25 mg/mL (2.5%). Prepared under USP <797> sterile-compounding standards; store refrigerated with a short beyond-use date per stability. Order-form SIG options: 1 drop into the affected eye every hour while awake; every 2 hours, then taper; or four times daily, or as prescribed.
Spectrum & use:
- Gram-positive coverage including MRSA/MRSE, streptococci, enterococci; no gram-negative coverage
- Bacterial keratitis / corneal ulcer; commonly paired with a fortified aminoglycoside or a fluoroquinolone for empiric broad coverage pending cultures (EyeWiki)
- Higher concentrations (e.g., 50 mg/mL) show greater in-vitro/experimental MRSA kill; 25 mg/mL is widely used for tolerability — select per clinical judgment and cultures
- Reassess with the culture and clinical course; manage under ophthalmology
Ordering: send a prescription to Bayview, or use our Vancomycin Ophthalmic order form (fax 401-284-4506). Service area: RI, MA, CT, NY, NJ, NH, FL. Background: EyeWiki, Bacterial Keratitis; Fortified vancomycin concentration study (IOVS).
This is a prescription compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your provider determines whether it is appropriate and sets the concentration, schedule, and length of treatment.
