For sight-threatening corneal ulcers, which fortified antibiotic is prescribed?

• A. Fortified Moxifloxacin
• B. Fortified Vancomycin
• C. Fortified Cefazolin
• D. Fortified Tobramycin/Gentamicin

Answer: (D)

In sight-threatening corneal ulcers, you need rapid, broad-spectrum coverage that reaches high concentrations at the cornea to quickly control the infection. An aminoglycoside prepared in a fortified dose—tobramycin or gentamicin—provides strong activity against Gram-negative bacteria, including Pseudomonas, which are common and can cause rapid vision-threatening progression. The fortified form achieves the high local concentrations needed for serious keratitis, making it the standard initial choice to cover the Gram-negative agents while still offering robust activity against many Gram-positives when used in combination with other agents. While vancomycin targets Gram-positive organisms, it doesn’t reliably cover Gram-negatives; cefazolin similarly focuses on Gram-positives; and although moxifloxacin has broad activity, fortified aminoglycosides remain a preferred choice for urgent, severe ulcers due to proven potency and rapid corneal penetration.