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Topical Antibiotic — Otitis Externa Pregnancy: Use with caution — topical use considered acceptable; avoid systemic chloramphenicol in pregnancy

Chloramphenicol Ear Drops

Brand names: Chloromycetin Ear Drops

Adult dose

Dose: 2–3 drops
Route: Otic (ear)
Frequency: Three times daily
Max: 3 drops per ear three times daily
Topical chloramphenicol for bacterial otitis externa. Used as second-line after topical acetic acid or ciprofloxacin ear drops. Broad-spectrum topical antibiotic effective against Staphylococcus aureus and Gram-negative bacteria. Not first-line due to concerns about sensitisation.

Paediatric dose

Dose: 2–3 drops drops/kg
Route: Otic
Frequency: Three times daily
Max: 3 drops per ear three times daily
BNFc: topical use in children — same dose as adults. Systemic chloramphenicol avoided in children under 2 years (grey baby syndrome) but topical otic route is safe.

Dose adjustments

Renal

No dose adjustment required (topical — negligible systemic absorption)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: topical use in children — same dose as adults. Systemic chloramphenicol avoided in children under 2 years (grey baby syndrome) but topical otic route is safe.

Clinical pearls

  • Less ototoxic than aminoglycoside ear drops — can be used with greater caution in perforated tympanic membrane (unlike gentamicin/neomycin which are contraindicated)
  • Contact sensitisation develops with repeated exposure — can cause topical allergy; if otitis externa fails to improve or worsens, consider sensitisation
  • First-line for uncomplicated otitis externa: acetic acid (EarCalm) or topical ciprofloxacin (Ciloxan) — chloramphenicol is second-line
  • Aural toilet: ideally performed by microsuction before instilling drops — maximises delivery to infected skin
  • MRSA otitis externa: chloramphenicol is usually active; ciprofloxacin ear drops are first-choice for Pseudomonas (common cause of malignant OE)

Contraindications

  • Perforated tympanic membrane (risk of ototoxicity — particularly with aminoglycoside ear drops; chloramphenicol less ototoxic but caution warranted)
  • Hypersensitivity to chloramphenicol

Side effects

  • Contact sensitisation (rash, eczema — with repeated exposure)
  • Local irritation
  • Rare: aplastic anaemia (reported with prolonged topical use but extremely rare)

Interactions

  • Negligible at topical otic doses

Monitoring

  • Symptom response at 7 days
  • Signs of sensitisation (worsening eczema or rash)

Reference: BNFc; BNF 90; BNFc; NICE CKS Otitis Externa; ENT-UK Guidelines for Otitis Externa. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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