Antibacterial eye preparations

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If asked to treat cases of conjunctivitis in patients aged 2 years and over, recommend simple eye cleansing measures (eg remove lash debris) in preference to chloramphenicol which has been shown to be no better than placebo. If there is no improvement after a few days consider a trial of chloramphenicol. Viral conjunctivitis is common and is self-limiting but may take several days to weeks to resolve. For the management of blepharitis encourage regular eyelid hygiene.

Chloramphenicol eye drops are well-tolerated and the recommendation that they should be avoided because of an increased risk of aplastic anaemia is not well-founded. Fusidic acid viscous eye drops can be administered twice daily, however they have a narrower spectrum of action than chloramphenicol and are significantly more expensive. 

CHLORAMPHENICOL (First Line)

Therapy notes

MHRA advice: Chloramphenicol eye drops containing borax or boric acid buffers: use in children younger than 2 years (July 2021) (www.gov.uk).

  • Chloramphenicol eye drops and ointment are available over the counter for adults and for children over the age of 2 years for a maximum of 5 days treatment; see Minor Ailments Service Formulary.

Formulation and dosage details

Formulation:

Eye drops 0·5%OTC

 

Dosage:

Eye drops: apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing.

Formulation and dosage details

Formulation:

Preservative-free eye drops 0·5%

Dosage:

Eye drops: apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing.

Formulation and dosage details

Formulation:

Eye ointment 1%OTC

Dosage:

Eye ointment: apply either at night (if drops used during the day) or 4 times daily (if eye ointment used alone).

FUSIDIC ACID (Second Line)

Therapy notes

Formulation and dosage details

Formulation:

Eye drops 1% (in gel basis)

Dosage:

Apply twice daily and continue for 48 hours after healing.

CEFUROXIME

Therapy notes

  • Available from special-order manufacturers; for information contact Medicines Information.

Formulation

Preservative-free eye drops 5% unlicensed (specialist use only)

GENTAMICIN

Therapy notes

  • The high strength gentamicin eye drops 1·5% unlicensed are available from special-order manufacturers; for information contact Medicines Information.

Formulation and dosage details

Formulation:

Drops 0·3%

Dosage:

Apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing.

Formulation and dosage details

Formulation:

Drops 1·5% (s)

Dosage:

Apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing.

LEVOFLOXACIN

Therapy notes

MHRA alert: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019) (www.gov.uk).

Formulation and dosage details

Formulation:

Eye drops 5mg/mL (s)

Dosage:

Apply 1 drop every 2 hours (maximum 8 times daily) for the first 2 days, then 4 times daily for 3 days.

OFLOXACIN

Therapy notes

MHRA alert: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019) (www.gov.uk).

Formulation and dosage details

Formulation:

Eye drops 0·3% (s)

Dosage:

Apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing. Treat for a maximum of 10 days.