11.3.1 Antibacterials

Administration

Frequency of application depends on the severity of the infection and the potential for irreversible ocular damage; antibacterial eye preparations are usually administered as follows:

  • Eye drops: apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing
  • Eye ointment: apply either at night (if eye drops used during the day) or 3–4 times daily (if eye ointment used alone)

Corticosteroid eye preparations combined with antibiotics should be used only for post-operative inflammation when bacterial infection is likely. See section 11.4

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over-the-counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is conjunctivitis.

Treatments of conjunctivitis are cheap to buy and are readily available OTC along with advice from pharmacies. Please click here for further information, exceptions, and a patient leaflet.

Chloramphenicol
  • Eye drops 0.5% (£7.30 = 10ml)
  • Eye ointment 1% (£2.32 = 4g)
  • Single dose eye drops preservative-free 0.5% for patients with a known allergy to the preservative (click here for preferred brand)

Indications

Dose

  • Drops: apply every 2 hours during day for first 48 hours, then four times a day until 48 hours after resolution (5-7 day course)
  • Ointment: apply 3-4 times daily until 48 hours after resolution (5-7 day course)

Notes

  1. Neonates with severe conjunctivitis should be referred urgently to secondary care
  2. MHRA Drug Safety Update (July 2021): Chloramphenicol eye drops containing borax or boric acid buffers: use in children younger than 2 years
    Chloramphenicol eye drops can be safely administered to children aged 0 to 2 years where antibiotic eye drop treatment is indicated.
    1. Some licences for chloramphenicol eye drop products containing borax or boric acid buffers were recently updated to restrict use in children younger than 2 years of age to reflect warnings on maximum daily limits for boron exposure
    2. The MHRA has reviewed the available evidence and sought independent expert advice. The MHRA has concluded that the benefits of chloramphenicol eye drops containing borax or boric acid outweigh the potential risks for children, including those aged 0 to 2 years
    3. The product information for affected chloramphenicol products is being updated to reflect the revised advice and remove restrictions for use in infants – in the meantime the MHRA asks healthcare professionals to reassure parents and carers that these products can be safely given to children aged 0 to 2 years as prescribed
    4. For more information and advice for parents and carers, see the Drug Safety Update
  3. The general consensus of opinion is that a link between aplastic anaemia and chloramphenicol eye drops has not been proven but as a precaution courses should be limited to 5-7 days and topical chloramphenicol should be avoided in patients with a personal or family history of blood dyscrasia
  4. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Fusidic acid
  • Eye drops 1% (£37.43 = 5g)

Dose

  • Apply twice a day

Notes

  1. Fusidic acid eye drops have a narrow spectrum of activity and should not be used for reasons of convenience. Fusidic acid eye drops should only be used if indicated by antimicrobial sensitivity or on specialist recommendation for an individual patient.
Gentamicin
  • Eye drops: 0.3% (for pseudomonas) (£2.46 = 10ml)
  • Forte eye drops: 1.5% (Moorfields)
  • Forte preservative-free eye drops: 1.5% (Moorfields)

Dose

  • One drop every 2 hours then reduce frequency as infection is controlled, continue for 48 hours after healing
Ofloxacin
  • Eye drops 0.3% (£2.17 = 5ml)

Dose

  • Apply every 2–4 hours for the first 2 days, then reduce frequency to 4 times daily (maximum 10 days treatment)
Propamidine
  • Eye drops 0.1% (£3.00 = 10ml)

Indications

  • Acanthamoeba keratitis (unlicensed indication)

Dose

  • Apply 1–2 times daily
Cefuroxime
  • Preservative-free eye drops 5%

 

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