How to Help Your Patients Find Polymyxin B/Trimethoprim in Stock: A Provider's Guide

If you've been fielding calls from patients who can't fill their Polymyxin B/Trimethoprim (Polytrim) prescription, you're not alone. Despite improved supply in 2026, pharmacy-level stock remains inconsistent. This guide provides your clinical team with practical strategies to support patients in finding their medication — and outlines when to pivot to alternatives.

Why Are Patients Having Trouble Filling Polymyxin B/Trimethoprim?

The 2023 closure of Akorn, Inc. — a major generic ophthalmic manufacturer — created a lasting supply disruption. While Bausch Health and Sandoz have stepped in to fill the gap, pharmacy ordering patterns, wholesaler allocations, and seasonal demand spikes mean that some pharmacies remain intermittently out of stock. Patients at chain pharmacies are particularly vulnerable to simultaneous stock-outs when a shared wholesaler is backordered.

Prescribing Strategies That Reduce Fulfillment Problems

Specify 'generic substitution acceptable' broadly: Note on the prescription that either Bausch or Sandoz generic versions are acceptable, giving pharmacists maximum flexibility to source whichever manufacturer they have.

Prescribe electronically with an alternative included: Some e-prescribing platforms allow you to send a primary and an alternate prescription simultaneously. Consider prescribing ciprofloxacin or moxifloxacin as an automatic backup the patient can use if Polytrim is unavailable within 24 hours.

Ask about the patient's pharmacy type: If your patient uses a major chain pharmacy, proactively recommend also checking independent pharmacies, which often source from different wholesalers.

Update your EHR workflow: Flag Polymyxin B/Trimethoprim in your order sets with a note about potential stock variability, and have preferred alternatives pre-populated for one-click prescribing.

Pharmacy-Finding Resources to Share With Patients

One of the most effective things you can do is direct patients to a pharmacy-finding service at the point of prescribing. medfinder calls pharmacies near the patient's location to check real-time stock and texts the patient the results. This eliminates the time-consuming process of patients calling pharmacies one by one — reducing both patient frustration and the volume of follow-up calls your office receives.

Another option: instruct your staff to give patients a simple calling script when they pick up a hard-copy prescription or receive a discharge:

Call your pharmacy and ask: 'Do you have polymyxin B sulfate/trimethoprim sulfate ophthalmic solution, 10 mL bottle, in stock today?'

If not, ask: 'Can you order it for me? How long will it take?'

If special order is too slow: 'Can you suggest a nearby pharmacy that might have it?'

When to Pivot to Alternatives

Establish a clear threshold with your office staff. A reasonable protocol:

If patient cannot fill within 24 hours of prescription: authorize a switch to ciprofloxacin ophthalmic 0.3%, which is widely available and clinically equivalent for mild bacterial conjunctivitis.

If corneal involvement is suspected or the patient presents with moderate-to-severe infection: prescribe a fluoroquinolone upfront regardless of Polytrim availability.

For pediatric patients under 2 months: use erythromycin ophthalmic ointment (polymyxin B/trimethoprim is not approved for this age group).

Patient Education Points

Equip your front desk and nursing staff with these talking points for patients who call about filling issues:

'The medication is available — your pharmacy may just need to order it or you may need to try a different pharmacy.'

'Independent pharmacies often have it when chain pharmacies don't.'

'If you can't fill it within 24 hours, call us back and we'll send an alternative prescription to your pharmacy.'

Summary

Polymyxin B/Trimethoprim is available but unevenly distributed across pharmacies. With proactive prescribing practices and clear protocols for when to switch, your office can minimize patient delays and reduce follow-up call volume. For more on the shortage background, see our provider shortage briefing for clinical context.