Topical ophthalmic (steroid + fluoroquinolone) Pregnancy: No or limited data in pregnant women; corticosteroids cross the placenta. Not recommended during pregnancy, and especially during the first three months, should only take place after a careful benefit-risk assessment. Breast-feeding: systemic corticosteroids and levofloxacin are excreted into human milk and a risk to the suckling child cannot be excluded (§4.6)

Dexamethasone with levofloxacin

Brand names: specials / various

This combined eye drop contains the corticosteroid dexamethasone with the fluoroquinolone antibiotic levofloxacin, used for ocular inflammation associated with, or at risk of, bacterial infection, including after ocular surgery.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop instilled into the conjunctival sac after surgery

Route: Ocular use (topical eye drops, solution)

Frequency: Every 6 hours

Max: Duration of treatment is 7 days; any follow-up treatment with steroid eye drops alone should not normally exceed 2 weeks (§4.2)

Source SPC is Ducressa 1 mg/ml + 5 mg/ml eye drops, solution (dexamethasone 1 mg/ml + levofloxacin 5 mg/ml) — the exact fixed combination. §4.2: 'One drop instilled into the conjunctival sac after surgery every 6 hours. Duration of treatment is 7 days. Care should be taken not to discontinue therapy prematurely. If one dose is missed, treatment should continue with the next dose as planned.' Re-evaluation of the patient to assess the need to continue corticosteroid eye drops as monotherapy is recommended after completing one week of Ducressa; the length of that follow-up treatment depends on the patient's risk factors and outcome of surgery and must be determined by the doctor according to slit-lamp findings and severity, and should not normally exceed 2 weeks. Elderly: no dosage adjustment necessary. Administration: instil one drop in the lateral canthus while applying pressure at the medial canthus to prevent drainage; nasolacrimal occlusion by compression of the lacrimal ducts may reduce systemic absorption; space instillations of other eye drops by 15 minutes. Must NOT be injected sub-conjunctivally and must not be introduced directly into the anterior chamber. Paediatric (§4.2): 'The safety and efficacy of Ducressa in children and adolescents below the age of 18 years have not been established. No data are available. Ducressa is not recommended for use in children and adolescents below the age of 18 years.' Monitor intraocular pressure frequently (steroid-induced ocular hypertension/glaucoma risk, increased in predisposed patients e.g. diabetes).

Dose adjustments

Renal

Not studied in patients with renal/hepatic impairment; should therefore be used with caution in such patients (§4.2)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to levofloxacin or other quinolones, to dexamethasone or other steroids, or to any of the excipients
Herpes simplex keratitis, varicella and other viral disease of the cornea and conjunctiva
Mycobacterial infections of the eye (including Mycobacterium tuberculosis, M. leprae, M. avium)
Fungal diseases of ocular structures
Untreated purulent infection of the eye

Side effects

Uncommon: eye irritation and abnormal sensation in the eye
Uncommon: ocular hypertension / intraocular pressure increased (>6 mmHg)
Uncommon: headache and dysgeusia
Uncommon: pruritus
With dexamethasone component — very common: increase of intraocular pressure; common: discomfort, irritation, burning, stinging, itching and blurred vision
With levofloxacin component — common: ocular burning, decreased vision, mucous strand; rare: extra-ocular allergic reactions including skin rash; very rare: anaphylaxis

Interactions

Other eye drop solutions — space instillations by 15 minutes (§4.2)
Topical ocular NSAIDs — concomitant use with steroids may increase the potential for corneal wound-healing problems (§4.4)
CYP3A4 inhibitors including ritonavir and cobicistat — predisposed patients may develop Cushing's syndrome and/or adrenal suppression from systemic absorption of ocular dexamethasone; discontinue progressively (§4.4)
Systemic fluoroquinolone therapy/concurrent corticosteroids — tendon inflammation and rupture may occur, particularly in older patients; discontinue at the first sign of tendon inflammation (§4.4)

Clinical monograph

How it works

Dexamethasone reduces inflammation by suppressing inflammatory mediators and vascular permeability, while levofloxacin inhibits bacterial DNA gyrase and topoisomerase IV to provide broad-spectrum bactericidal activity.

Prescribing in practice

The corticosteroid is contraindicated in undiagnosed red eye and suspected herpes simplex (dendritic) keratitis, where steroids risk corneal perforation, so a viral cause must be excluded before use.
Prolonged steroid exposure can raise intraocular pressure and promote cataract and secondary infection, so treatment should be short and supervised.
Avoid contact lens wear during active infection and counsel on correct instillation and storage.

Monitoring

Monitor intraocular pressure with extended use and review corneal status and clinical response, discontinuing if infection or inflammation worsens.

Counselling the patient

Use exactly as prescribed for the stated course and complete the antibiotic component.
Report increasing pain, redness or visual disturbance promptly.
Remove contact lenses while using the drops unless told otherwise.

Evidence & guidelines

Fixed steroid-fluoroquinolone eye drops are an established option for post-surgical and infective-inflammatory ocular conditions, with safety depending on excluding viral keratitis and limiting duration.

Reference: RCOphth; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways