Chloramphenicol Eye Drops/Ointment

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.