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For this reason, antibiotic eye drops must be used multiple times per day to prevent and treat ocular infections. Frequent eye drop use is inconvenient for patients, and lack of adherence to prescribed dosing regimens limits treatment efficacy and contributes to antibiotic resistance. Here, we describe an ion\u2010pairing approach used to create an insoluble moxifloxacin\u2013pamoate (MOX\u2013PAM) complex for formulation into mucus\u2010penetrating nanosuspension eye drops (MOX\u2013PAM NS). The MOX\u2013PAM NS provided a significant increase in ocular drug absorption, as measured by the area under the curve in cornea tissue and aqueous humor, compared to Vigamox in healthy rats. Prophylactic and treatment efficacy were evaluated in a rat model of ocular <jats:italic>Staphylococcus aureus<\/jats:italic> infection. A single drop of MOX\u2013PAM NS was more effective than Vigamox, and completely prevented infection. Once a day dosing with MOX\u2013PAM NS was similar, if not more effective, than three times a day dosing with Vigamox for treating <jats:italic>S. aureus<\/jats:italic> infection. The MOX\u2013PAM NS provided increased intraocular antibiotic absorption and improved prevention and treatment of ocular keratitis, and the formulation approach is highly translational and clinically relevant.<\/jats:p>","DOI":"10.1002\/btm2.10238","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T08:59:31Z","timestamp":1623920371000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["An ion\u2010paired moxifloxacin nanosuspension eye drop provides improved prevention and treatment of ocular infection"],"prefix":"10.1002","volume":"6","author":[{"given":"Aditya","family":"Josyula","sequence":"first","affiliation":[{"name":"The Center for Nanomedicine, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Chemical and Biomolecular Engineering Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Revaz","family":"Omiadze","sequence":"additional","affiliation":[{"name":"The Center for Nanomedicine, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Ophthalmology, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3483-7429","authenticated-orcid":false,"given":"Kunal","family":"Parikh","sequence":"additional","affiliation":[{"name":"The Center for Nanomedicine, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Ophthalmology, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Biomedical Engineering Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Center for Bioengineering Innovation and Design Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranjali","family":"Kanvinde","sequence":"additional","affiliation":[{"name":"The Center for Nanomedicine, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Ophthalmology, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew B.","family":"Appell","sequence":"additional","affiliation":[{"name":"The Center for Nanomedicine, The Wilmer Eye Institute Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Pharmacology and Molecular Sciences Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratikkumar","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences, The Daniel K. 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