Antibacterial eye preparations (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

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).

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 and dosage details

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 advice: Flouroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate.  Updated safety advice is available here including a patient information leaflet.  Side effects may be disabling, long-lasting and sometimes irreversible.  Systems affected include musculoskeletal (tendonitis/rupture), neurological (muscle weakness), sensory (peripheral neuropathy) and psychiatric (tiredness, anxiety, depression and suicidal thoughts).  Fluoroquinolones should not be prescribed for self-limiting or mild to moderate infections or non-bacterial (chronic) prostatitis (January 2024).

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 advice: Flouroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate.  Updated safety advice is available here including a patient information leaflet.  Side effects may be disabling, long-lasting and sometimes irreversible.  Systems affected include musculoskeletal (tendonitis/rupture), neurological (muscle weakness), sensory (peripheral neuropathy) and psychiatric (tiredness, anxiety, depression and suicidal thoughts).  Fluoroquinolones should not be prescribed for self-limiting or mild to moderate infections or non-bacterial (chronic) prostatitis (January 2024).

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.

Editorial Information

Document Id: F200