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11.3 Anti-infective eye preparations

11.3.1 Antibacterials

Chloramphenicol drops (1st line agent), minims, ointment
Fusidic acid eye drops - alternative for patients with chloramphenicol allergy
Cefuroxime drops (hospital only 5%)
Ciprofloxacin drops
Levofloxacin drops - see note
Gentamicin drops
Azithromycin 1.5% eye drop (Azyter)

Acanthamoeba keratitis
Propamidine isetionate drops
Polyhexamethylene biguanide (PHMB) - 'Polihexanide' 0.02% drops (Moorfield's Special)
Hexamidine 0.1% lotion (unlicensed product/import)

Notes:

1. Chloramphenicol is an effective, broad spectrum agent that may be used for 'blind' treatment of infections without increasing resistance to the usual systemic antibiotics. This is the first line agent for the treatment of purulent bacterial conjunctivitis.

2. Gentamicin is used for infections due to Pseudomonas or resistant Staphylococci. It is included as a second line agent to chloramphenicol

3. Propamidine (Brolene) eye drops are included for use in Acanthamoeba keratitis only. It is not effective for bacterial infections. Polihexanide and Hexamidine may also be used for Acanthamoeba keratitis. Combination therapy is probably necessary.

4. Levofloxacin eye drops are reserved for corneal ulceration in adults and for bacterial eye infections in children (replacing combined therapy of ciprofloxacin and cefuroxime).

5. Azithromycin 1.5% eye drop is recommended for the local antibacterial treatment of conjunctivitis caused by susceptible strains: purulent bacterial conjunctivitis (2nd line agent), trachomatous conjunctivitis caused by Chlamydia trachomatis (first line agent).

 

11.3.3 Antivirals

Aciclovir eye ointment 3%
Ganciclovir drops (Hospital only)
Trifluorothymidine drops (Hospital only)

Notes:

1. Topical aciclovir is effective in localised Herpes simplex infections; the oral route must be used in Herpes zoster ophthalmicus.

2. Ganciclovir is second line for acute herpes simplex keratitis in patients intolerant/resistant to aciclovir eye ointment.

3. Trifluorothymidine, which is unlicensed, is a third line option.

 

For link to BNF section: 11.3 Anti-infective eye preparations