11.3.1 Antibacterials


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.




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


  1. 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 safety update
  2. 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% (£29.06 = 5g)


  • Apply twice a day
  • Eye drops: 0.3% (for pseudomonas) (£2.46 = 10ml)
  • Forte eye drops: 1.5% (Moorfields)
  • Forte preservative-free eye drops: 1.5% (Moorfields)


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


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


  • Acanthamoeba keratitis (unlicensed indication)


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


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