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Topical antibiotic (ophthalmic) Pregnancy: Not recommended. §4.6: 'The safety of Chloramphenicol Eye Drops during pregnancy and lactation has not been established. Chloramphenicol may be absorbed systemically following the use of eye drops and may cross the placenta and appear in breast milk. Therefore this product is not recommended for use during pregnancy and lactation.'

Chloramphenicol Eye Drops/Ointment

Brand names: Minims Chloramphenicol, Golden Eye (OTC)

Used in: Acute Red Eye

Chloramphenicol eye drops and ointment are a broad-spectrum topical antibacterial used for superficial bacterial eye infections such as acute bacterial conjunctivitis.

Adult dose

Dose: One drop of 0.5% w/v chloramphenicol eye drops to the affected eye
Route: Ophthalmic (0.5% w/v eye drops)
Frequency: Every two hours for the first 48 hours, then four-hourly; during waking hours only; continue for 5 days
SCOPE: eye DROPS only — the SPC in this bundle is for a 0.5% w/v drop product, so it does not cover the 1% eye ointment this page also lists, and no ointment regimen is published here. §4.2 verbatim: 'For ocular use. The recommended dosage for adults (including the elderly) and children aged 2 years and over is one drop to be applied to the affected eye every two hours for the first 48 hours and 4 hourly thereafter. To be used during waking hours only. Treatment should continue for 5 days, even if symptoms improve.' The drop count is publishable because the product strength is pinned by the product name (0.5% w/v). No numeric maximum dose is stated; the SPC instead caps DURATION — §4.4: 'Prolonged use of chloramphenicol eye drops should be avoided as it may increase the likelihood of sensitisation and emergence of resistant organisms. Do not use for more than 5 days without consulting a doctor.' Contact lenses: '§4.4 ... contact lenses should not be worn during the course of treatment. Soft contact lenses should not be replaced for 24 hours after completing treatment.' Discard any remaining drops after the five-day course.

Paediatric dose

Route: Ophthalmic (0.5% w/v eye drops)
Frequency: Every two hours for the first 48 hours, then four-hourly; during waking hours only; continue for 5 days
Dosing is by drop count, not by weight, so there is no per-kg figure for the calculator. §4.2: the recommended dosage 'for adults (including the elderly) and children aged 2 years and over is one drop to be applied to the affected eye every two hours for the first 48 hours and 4 hourly thereafter.' Product strength is 0.5% w/v chloramphenicol.

Dose adjustments

Renal

Not addressed in this bundle — the SPC for the 0.5% w/v eye drops gives no renal dose adjustment.

Hepatic

Not addressed in this bundle — the SPC for the 0.5% w/v eye drops gives no hepatic dose adjustment.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to chloramphenicol or any other ingredient in the formulation
  • Known personal or family history of blood dyscrasias including aplastic anaemia

Side effects

  • Transient stinging and irritation when applied to the eye
  • Bone marrow depression, including irreversible and fatal aplastic anaemia, reported following topical use of chloramphenicol — §4.8: 'Whilst the hazard is a rare one, it should be borne in mind when assessing the benefits expected from the use of this compound'
  • Hypersensitivity reactions including angioedema

Monitoring

  • Clinical response — §4.4: 'Medical advice should be sought if there is no improvement in the condition after 2 days or if symptoms worsen at any time.'
  • Refer to a doctor for any of: disturbed vision, severe pain within the eye, photophobia, eye inflammation associated with a rash on the scalp or face, the eye looks cloudy, the pupil looks unusual, or a suspected foreign body in the eye (§4.4)
  • Refer to a doctor if the history includes: previous conjunctivitis in the recent past, glaucoma, dry eye syndrome, eye surgery or laser treatment in the last 6 months, eye injury, current use of other eye drops or ointment, or contact lens use (§4.4)
  • Treatment duration — do not use for more than 5 days without consulting a doctor (§4.4)
  • Avoid concomitant drugs liable to depress bone marrow function (§4.5)

Clinical monograph

How it works

Chloramphenicol inhibits bacterial protein synthesis by binding the 50S ribosomal subunit and blocking peptidyl transferase, an action that is bacteriostatic against most susceptible organisms.

Prescribing in practice

  • Avoid in patients with a personal or family history of blood dyscrasias or bone-marrow disorders, given the theoretical concern over serious haematological toxicity.
  • Reserve for confirmed or strongly suspected bacterial conjunctivitis, as many cases are viral or self-limiting.
  • The ointment causes temporary blurring and is useful at night, while drops are used during the day.

Monitoring

Monitor the clinical response and seek review if the infection fails to improve or worsens within a few days of starting treatment.

Counselling the patient

  • Complete the recommended course and continue for a short period after symptoms settle.
  • Do not share the medicine or eye make-up, and avoid wearing contact lenses during the infection.
  • The ointment will blur vision temporarily; apply it at night where possible.

Evidence & guidelines

Topical chloramphenicol is a long-established first-line treatment for acute bacterial conjunctivitis and is available over the counter for this indication in the UK.

Reference: NICE guidance Conjunctivitis; RCGP guidance; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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