Maxitrol Shortage: What Providers and Prescribers Need to Know in 2026

Maxitrol (neomycin and polymyxin B sulfates/dexamethasone ophthalmic) is one of the most widely prescribed topical ophthalmic combination antibiotic-steroid medications in the United States, with decades of use dating back to its original FDA approval in October 1964. While no national shortage is currently declared for Maxitrol, many providers are fielding calls from patients who cannot find it at local pharmacies. This clinical guide is designed to help ophthalmologists, optometrists, and primary care prescribers navigate 2026 availability challenges and support their patients effectively.

Current Availability Status of Maxitrol

As of 2026, Maxitrol is not listed on the FDA Drug Shortage Database. This means national supply is considered sufficient to meet national demand. However, a key limitation of FDA shortage designations is that they operate at the national level and do not capture localized distribution disruptions. Providers should anticipate ongoing calls from patients who cannot fill their prescription at a specific pharmacy location, even when the drug is broadly available.

The generic formulation (neomycin/polymyxin B/dexamethasone ophthalmic) is produced by multiple manufacturers, which provides supply redundancy. Brand-name Maxitrol, distributed by Alcon Laboratories, may have more variable local availability depending on the distributor network serving a given area.

Clinical Use Overview

Maxitrol is FDA-indicated for steroid-responsive inflammatory ocular conditions in which corticosteroid treatment is appropriate and where bacterial infection or risk of bacterial infection exists. This includes:

Bacterial conjunctivitis with associated inflammation

Blepharitis and blepharoconjunctivitis

Anterior segment uveitis with infection risk

Keratoconjunctivitis

Post-cataract surgery inflammation (first week; commonly used in cataract surgery protocols)

Chemical, radiation, or physical trauma to the anterior eye

The antibiotic spectrum covers Staphylococcus aureus, Escherichia coli, Haemophilus influenzae, Klebsiella/Enterobacter species, Neisseria species, and Pseudomonas aeruginosa. It does not provide adequate coverage against Serratia marcescens or streptococci (including S. pneumoniae).

Dosing Reference

Ophthalmic suspension: 1-2 drops in affected eye(s) q4-6h; may be used hourly in severe disease, tapering as inflammation resolves. Initial prescription limit: 20 mL; do not refill without re-evaluation.

Ophthalmic ointment: ~0.5-inch ribbon applied to conjunctival sac q4-6h or as adjunct to suspension. Initial prescription limit: 8 g.

IOP monitoring: Required if therapy exceeds 10 days. Monitor even in patients who may be uncooperative.

Appropriate Therapeutic Alternatives for 2026

When Maxitrol is unavailable or contraindicated, the following alternatives should be considered based on clinical appropriateness:

TobraDex (tobramycin 0.3%/dexamethasone 0.1%): The most clinically interchangeable alternative. Generic available. First-line choice when neomycin allergy is suspected or confirmed (sensitization rate to neomycin in the general population is reported at approximately 8-10%).

Zylet (tobramycin 0.3%/loteprednol 0.5%): Preferred in glaucoma suspects or patients with documented steroid-response IOP elevation. No generic currently available — consider cost impact.

Blephamide (sulfacetamide 10%/prednisolone 0.2%): Viable alternative in sulfa-tolerant patients. Generic available. Avoid if sulfa allergy is present.

Prednisolone acetate 1% + separate antibiotic: Flexible split approach using Pred Forte or generic prednisolone with a fluoroquinolone (ciprofloxacin, moxifloxacin, besifloxacin) based on clinical indication and resistance patterns.

Contraindications and Safety Reminders

Regardless of availability, remind patients and your clinical team of the key contraindications for Maxitrol and its class:

Contraindicated in fungal, viral (including epithelial herpes simplex keratitis), vaccinia, varicella, and mycobacterial infections of the eye

Use with caution in the presence of acute purulent infections (corticosteroid component may mask or enhance infection)

Risk of corneal/scleral thinning and perforation in patients with thin corneal tissue

Neomycin sensitization — assess prior to prescribing, particularly for patients with prior topical neomycin use

How to Help Your Patients Find Maxitrol

When patients cannot fill Maxitrol at their usual pharmacy, directing them to medfinder.com/providers can reduce the administrative burden on your office while ensuring patients get their medication quickly. medfinder calls pharmacies on behalf of patients to locate available stock, then texts results to the patient. This can significantly reduce the volume of callback requests your office receives from patients who can't fill their prescriptions.

For more practical guidance on directing patients to pharmacy resources, see our companion guide: How to Help Your Patients Find Maxitrol in Stock: A Provider's Guide.