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Topical antibiotic (ophthalmic) Pregnancy: Use with caution; significant systemic absorption unlikely with topical route but avoid if possible.

Chloramphenicol Eye Drops/Ointment

Brand names: Minims Chloramphenicol, Golden Eye (OTC)

Adult dose

Dose: 1 drop every 2 hours (acute), reducing to 4 times daily as improves; ointment at night
Route: Ophthalmic (drops or ointment)
Frequency: Every 2 hours initially (severe); 4 times daily (mild); ointment at night
Max: 1 drop per application
Bacterial conjunctivitis: 0.5% drops every 2 hours for first 48 hours, reducing to QDS for 5 days. 1% ointment at night. Most acute conjunctivitis is viral — antibiotics not required unless bacterial features or risk factors.

Paediatric dose

Route: Ophthalmic
Frequency: Every 2 hours initially then 4 times daily
Max: Same as adult
Same dosing as adults from birth. Neonatal ophthalmia (gonococcal): specialist treatment required (IV ceftriaxone). Chloramphenicol drops/ointment can be used from birth for other bacterial conjunctivitis.

Dose adjustments

Renal

No systemic adjustment for ophthalmic use.

Hepatic

No systemic adjustment for ophthalmic use.

Clinical pearls

  • Most common first-line topical antibiotic for bacterial conjunctivitis in UK
  • Available OTC (Golden Eye — adults; not for <2 years OTC)
  • Viral conjunctivitis: self-limiting — no antibiotics; cool compress and hygiene measures
  • Gonococcal or chlamydial conjunctivitis: topical treatment alone insufficient — systemic antibiotics required
  • Aplastic anaemia risk with topical use is theoretical (not well established) — benefit outweighs risk

Contraindications

  • Personal or family history of chloramphenicol-induced aplastic anaemia
  • Hypersensitivity to chloramphenicol

Side effects

  • Stinging on instillation
  • Aplastic anaemia (extremely rare — idiosyncratic with topical use; case reports only)
  • Local hypersensitivity reaction
  • Bone marrow suppression (systemic — NOT with topical)

Interactions

  • No significant systemic interactions from ophthalmic use

Monitoring

  • Clinical response at 48–72 hours
  • Corneal staining (slit lamp) if not improving

Reference: BNFc; BNF; NICE guidance Conjunctivitis; RCGP guidance. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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