11.3.1 Antibacterials

Most acute superficial eye infections can be treated topically.

Most cases of acute bacterial conjunctivitis are self-limiting. Where treatment is appropriate, antibacterial eye drops or an eye ointment are used. A poor response might indicate viral or allergic conjunctivitis.

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 for 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.

Administration:

  • Eye drops (non-viscous) – 1 drop at least every 2 hours for 48 hours. Frequency reduced as infection controlled and to continue for 48 hours after evidence of response, up to 2 weeks.
  • Eye ointment – apply 3-4 times a day unless using an eye drop in the daytime when ointment application is at night only.
  • If there is no response to treatment it is advisable that a swab is taken before changing the antibiotic.
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 (£11.43 = 20 units)

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 those patients with a personal or family history of blood dyscrasia
Ciprofloxacin
  • Ophthalmic solution 0.3% (£4.70 = 5ml)

Indications

  • Bacterial eye infections
  • Corneal ulcers

Dose

  • Superficial bacterial infection:
    • Apply eye drops 4 times daily; in severe infection apply every 2 hours during waking hours for 2 days, then 4 times daily; max. duration of treatment 21 days
  • Corneal ulcer:
    • Apply eye drops throughout day and night, day 1 apply every 15 minutes for 6 hours then every 30 minutes, day 2 apply every hour, days 3–14 apply every 4 hours; max. duration of treatment 21 days
Fusidic acid
  • Eye drops 1% (£37.43 = 5g)

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% (£2.46 = 10ml)
  • Preservative free eye drops 1.5% (unlicensed preparation)
  • Eye drops 1.5% (unlicensed preparation)

Indications

  • Acute bacterial conjunctivitis

Dose

  • One drop every 2 hours then reduce frequency as infection is controlled, continue for 48 hours after healing

Notes

  1. Gentamicin eye drops are suggested as a specialist initiated antibiotic or when specifically indicated by culture
Ofloxacin
  • Ophthalmic solution 0.3% (£2.17 = 5ml)

Indications

  • Bacterial eye infections

Dose

  • Apply every 2–4 hours for the first 2 days, then reduce frequency to 4 times daily (maximum 10 days treatment)
Amikacin
  • Eye drops preservative free 2.5% (unlicensed preparation)
Benzylpenicillin
  • Eye drops preservative free 5000U/ml (unlicensed preparation)
Ceftazidime
  • Intravitreal Injection 2mg in 0.1ml (unlicensed preparation)
Cefuroxime
  • Preservative free eye drops 5% (unlicensed preparation)
Erythromycin
  • Eye ointment 0.5% (unlicensed preparation)
Moxifloxacin
  • Eye drops 0.5%
Vancomycin
  • 2mg in 0.1ml intravitrial injection (unlicensed preparation)

 

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