Download Principles of treatment

BEDFORDSHIRE COMMUNITY
ANTIMICROBIAL
PRESCRIBING
GUIDELINES
2008
"Addressing known local sensitivities"
Before you open this book …..
Do you need to prescribe an antibiotic or is it a virus?
VIRUS? Symbol means that a virus is commonly involved
Introduction
These Guidelines are intended to assist General Practitioners in choosing appropriate first line antimicrobial agents for
commonly encountered community acquired infections. Local sensitivity patterns of common pathogens have been
taken into account. Bear in mind that, if the patient has recently been on an antibiotic, resistant organisms may have
been selected out requiring a change of therapy if further treatment is indicated.
It is very useful to take specimens for culture before starting treatment; preliminary results are usually available the
following day. Treatment may need to be altered once culture and sensitivity results are available. More detailed
advice on treatment options may be obtained from the Consultant Microbiologists at the respective hospitals.
Doses given are for normal weight adults, unless otherwise stated. Always refer to the BNF to check
paediatric doses, contra-indications and side-effects. If the patient is genuinely allergic to penicillin use
erythromycin for presumed gram positive infections.
THESE GUIDELINES ARE BASED ON THE BEST AVAILABLE EVIDENCE BUT THEIR APPLICATION MUST BE
MODIFIED BY PROFESSIONAL JUDGEMENT
Aims

To assist GPs in choosing empirical antimicrobial agents for common community infections.

To minimise the emergence of bacterial resistance in the community.

To encourage rational and cost-effective use of antibiotics.

To aim to mimimise incidence of antibiotic associated Clostridium difficile & MRSA infections

To aim to minimise incidence of toxicity and other adverse effects associated with antibiotic prescribing

To aim to promote the safe and appropriate use of antibiotics encouraging patient education
Principles of treatment
1. Prescribe an antibiotic only when there is likely to be a clear clinical benefit. Evidence clearly links increased risk
of opportunist infections such as C. difficile with high volume prescribing of antibiotics
2. Do not prescribe an antibiotic for viral infections.
3. Limit prescribing over the telephone to really exceptional cases.
4. Consider patient compliance issues which may influence drug choice, dose frequency and length of
treatment.Check ability to swallow tablets or capsules and prescribe acceptable dose form. Include patient
counselling to explain reason for full compliance
5. Reduce or avoid the use of broad spectrum antibiotics, particularly cephalosporins and quinolones, as much as
possible. When antibiotics are necessary and appropriate, use standard and cost effective ones.
6. Topical antibiotics have very limited indications and should be used sparingly.
7. In pregnancy avoid tetracyclines, aminoglycosides, quinolones, high dose metronidazole, trimethoprim (in the first
trimester) and nitrofurantoin (in the third trimester).
8. Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological advice can be obtained
from the consultant microbiologists at the Luton and Dunstable Hospital (01582 497318/497319) or Bedford
Hospital (01234 795913).
9. Duration of therapy depends on the nature of the infection and response to treatment. Please refer to the BNF
section 5.1 if unsure. In addition, the principle of treatment duration should aim to be minimal length to achieve
effect -in uncomplicated infections evidence would indicate 5 days to be adequate.
10. Samples should be sent for culture where infections are persistent or recurrent.
1
Respiratory Tract Infections
In both upper and lower respiratory tract infections, excluding Pharyngitis, Streptococcus
pneumoniae is the commonest pathogen, and if antibiotics are indicated, this organism must be
covered. Remember, presently available quinolones (e.g. ciprofloxacin) have insufficient activity
against S. pneumoniae. Antibiotics are rarely indicated for upper respiratory tract infections and an
NNT value of 4000 to prevent one serious complication has been calculated. (Paterson et al BMJ
2007 335:982). Patient education is particularly important in this area in line with National
programmes to reduce prescribing
Pharyngitis / Tonsillitis
Antibiotics should not be used to secure symptomatic relief in sore throats. The majority of sore
throats are viral; however there is clinical overlap between viral and streptococcal infections.
Antibiotics only shorten duration of symptoms by 8 hours. Antibiotics can prevent non-suppurative
complications of -haemolytic streptococcal pharyngitis but, in developed societies, such
complications are rare. NICE recommends antibiotics in the following situation, features of marked
systemic upset secondary to the acute sore throat, unilateral peritonsillitis, a history of rheumatic
fever or an increased risk from acute infection (such as a child with diabetes or
immunodeficiency). Results of a bacterial throat swab can be available within 2 working days but a
Group A streptococcal infection will be notified in 24 hours.
Drug Name
Dose
Frequency
Duration
Comments
Virus?
Penicillin V
500mg
Amoxicillin
250500mg
Erythromycin
*
500mg
four times
daily
three times
daily
10 days
two or four
times daily
10 days
This is absorbed better than penV and may be
used as an alternative if compliance is an issue.
Maculopapular rashes commonly occur with
amoxicillin but are not usually true penicillin allergy
-do not use blindly or if glandular fever is a
possibility.
10 days
Acute Otitis Media
Available evidence suggests that antibiotic treatment should NOT be routinely prescribed as 80%
of cases resolve within 3 days without antibiotics. Use NSAID or paracetamol. A study of
predictors of poor outcome found that in children with AOM but without fever and vomiting,
antibiotic treatment had little benefit. The lack of antibiotic did not lead to a poor outcome. The
simplest method to target the minority of children at higher risk of poor outcome would be to select
for antibiotic treatment those children with systemic features (ie either high temperature or
vomiting). Poor outcome more likely if recurrent.
Antibiotics do not reduce pain in first 24 hours, subsequent attacks or deafness and their use is
associated with increased adverse effects, such as nausea and diarrhoea. Viruses are a common
cause, but if antibiotics are indicated use:
Drug Name
Dose
Frequency
Duration
Comments
Virus?
Amoxicillin
250-500mg
Erythromycin*
500mg
three times
daily
two or four
times daily
5 days
(maximum)
5 days
(maximum)
2
First line choice.
For paediatric doses see BNF.
For paediatric doses see BNF.
*Clarithromycin is an acceptable alternative in those unable to tolerate erythromycin.
10 days treatment for confirmed Group A streptococcus
Acute Sinusitis
Usually self-limiting. Reserve treatment for severe or persistent cases of at least 7 days duration in
adults and 10-14 days duration in children There is very little evidence that antimicrobials are
effective in children and many infections are viral, resolving in 7 days.
Drug Name
Dose
Amoxicillin
250-500mg
Erythromycin*
500mg
Frequenc
y
Duration
Comments
three times
daily
two to four
times daily
5 days
(maximum)
5 days
(maximum)
Virus?
*Clarithromycin is an acceptable alternative in those unable to tolerate erythromycin.
10 days treatment for confirmed Group A streptococcus
Acute Bronchitis Virus?
Systematic reviews indicate benefits of antibiotics are marginal in otherwise healthy adults.
Acute Exacerbations of Chronic Bronchitis
Viral infections may cause acute exacerbations, but if purulent sputum is being produced, bacterial
infection is possible. NB Culture of the sputum is advised prior to initiation of therapy.
Drug Name
Dose
Frequency
Duration
Comments
Virus?
CoAmoxiclav
625mg
three times daily 5 days
Doxycycline
200mg
once daily
then
100mg
once daily
first day
only
for 4 more
days
May be considered as
an alternative and can
be used cautiously in
renal impairment
Erythromycin is an acceptable alternative for true penicillin allergy
Uncomplicated community acquired pneumonia
Patients with severe pneumonia will usually need hospital admission for nursing and intravenous
therapy.
Drug Name
Dose
Frequency
Duration
Amoxicillin
500mg
three times
daily
7 days
Erythromycin*
500mg
four times
daily
7 days
Comments
Severe staphyloccocal pneumonia can
occur following viral influenza- such
patients require urgent referral
For atypical pneumonia if no response to
amoxicillin after 48 hours add in
erythromycin and review again
*Clarithromycin is an acceptable alternative in those unable to tolerate erythromycin.
3
Urinary Tract Infections
Uncomplicated Lower Urinary Tract Infection Eg otherwise healthy women who are not
pregnant
Drug Name
Dose
Frequency
Duration
Trimethoprim
200mg
twice daily
3 days
Nitrofurantoin MR
100mg
twice daily
3 days
375mg
Three times a
day
3 days
Comments
First line ONLY for patients not
presenting with previous infection
and treatment in last 6 months
OTHERWISE:
Co-amoxiclav
Complicated Urinary Tract Infection
E.g. treatment of men, children and pregnant women, recurrent infection, pyelonephritis, stone,
tumour, etc.
An MSU should be sent prior to treatment and antimicrobial choice should be reassessed when
urine culture results are available
Drug Name
Dose
Frequency
Duration
Nitrofurantoin
MR
100mg
twice daily
7 days
Co-amoxiclav
625mg
three times
daily
7 days
Cefalexin
250mg
or
500mg
four times daily
7 days
twice daily
7 days
Comments
Not in third trimester Add to
comments box- not to be used in
treatment of upper UTIs e.g.
pyelonephritis as it does not
achieve adequate blood levels.
Not recommended in pregnancy
Can be used to treat
pyelonephritis. For penicillin
allergies refer to consultant
microbiologist
Appropriate ONLY in
pregnancy
Ciprofloxacin only appropriate for the treatment of confirmed pseudomonas infection
Prostatitis
An MSU should be sent prior to the start of treatment. Antimicrobial choice should be reassessed
when urine culture results are available
4
Drug Name
Ofloxacin
Dose
200mg
Frequency
twice daily
Duration
28 days
Comments
Acute episode- Add Doxycycline 100mg
twice a day duration 4-6 weeks into
treatment if Chlamydia is suspected
(sexually active)- consider referral to
GUM clinic
In Chronic Prostatitis: Ofloxacin 200mg bd for 28 days and refer to urology. It may be necessary to seek
specialist opinion.
Epididymo - Orchitis
Treatment depends whether the male is sexually active or not. In sexually active male, chlamydia
should be considered.
Drug Name
Dose
Frequency
Duration
Comments
Doxycycline
PLUS
Cefixime 400mg
Ofloxacin
100mg
twice daily
14 days
500mg
400mg
single dose
twice daily
14 days
In the sexually
active male. Refer
to GUM clinic.
As second line
when Doxycycline is
unsuitable
Ciprofloxacin
500mg
twice daily
10-14 days Non-sexually active
male
Refer to GRASP surveillance programme. (Gonococcal Resistance to Antimicrobials Surveillance
Programme).For non sexually active men, ciprofloxacin 500mg twice daily for 10-14 days can be given or
changed according to sensitivity results
Catheter Urines
1. Catheters inevitably become colonised by bacteria after a few days, and therefore there is NO
VALUE in sending urine from those with longstanding catheters. Treatment may be indicated
if the patient is systemically unwell.
2. Cloudiness and smell in the urine are not reasons for culturing urine.
3. Inappropriate antibiotics will not eradicate colonising bacteria, but will induce resistance.
4. Antibiotic and antiseptic bladder washouts are not recommended.
5
Genital Infections
Vaginal Discharge in a Child
Commonly due to Streptococcus pyogenes (Group A haemolytic streptococci), and occasionally to
Haemophilus influenzae, but possibility of sexual abuse should be considered. Vulval swab
should be sent for culture. Antimicrobial choice should be reassessed when results are available
Drug Name
Amoxicillin
Dose
Refer to BNF for paediatric doses.
Vaginal Discharge in an Adult
Common causes are chlamydia, trichomonas, candidiasis and bacterial vaginosis. Culture
samples required as listed under Pelvic Inflammatory Disease.
Trichomonas vaginalis
Drug Name
Dose
Frequency
Duration
Metronidazole
400 mg
twice daily
7 days
Metronidazole
2g
one dose only
Comments
Not in breastfeeding
or pregnancy
Treatment of the sexual partner may be indicated, especially if there is recurrence of the infection.
Candidiasis
Drug Name
Dose
Frequency
Duration
Comments
Clotrimazole
pessaries
500mg
once at night
1 day
Available OTC
Fluconazole
capsules
150mg
once daily
1 day
Available OTC. For
persistent infections.
Not in pregnancy.
Oral fluconazole is expensive. With recurrent infections, consider treating the sexual partner.
6
Bacterial Vaginosis
Drug Name
Dose
Frequency
Duration
Comments
Metronidazole
400mg
twice daily
7 days
Metronidazole
2g
one dose only
Clindamycin
cream 2%
5g
once each
night
Preferred regimen in
pregnancy
Not in breastfeeding
or pregnancy
If unable to tolerate
metronidazole
3-7 days
Specific STIs


All sexually transmitted infections are becoming more common. Syphilis Serology is
advisable.
Patients with sexually transmitted diseases and their partners require full microbiological
investigation and referral to the GUM clinic. (Bedford Hospital GUM Clinic 01234 792146 and
L&D Hospital GUM Clinic 01582 497071/497070)
Pelvic Inflammatory Disease (PID)



A chlamydia swab of the cervix (and urethra) and bacterial swabs from both the cervix and high
vagina are important to determine the correct aetiology.
Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in PID.
Occasionally organisms forming part of the normal vaginal flora may be implicated. Treatment,
until the identity of the pathogen is known, is broad spectrum:
Drug Name
Dose
Frequency
Cefixime
400mg
Single dose
100mg
twice daily
14 days
400mg
twice daily
14 days
400mg
twice a day
14 days
400mg
twice a day
14 days
plus
Doxycyline
Plus
Metronidazole
Ofloxacin
PLUS
metronidazole
Duration
Comments
This option for
treatment should
only be used after
discussion with
microbiologist
If a high possibility of gonorrhoea, add ciprofloxacin 500 mg one dose only. If laboratory subsequently reports N.
gonorrhoeae, treat with an appropriate antibiotic to which the organism is sensitive for 10 days. If urine test for
Chlamydia is done, there is no need for swabs. When swabs are taken however, tests for Gonorrhoea can be done
which is of value in follow up and partner notification.
7
Chlamydia trachomatis
Drug Name
Dose
Frequency
Duration
Comments
Azithromycin**
1g
one dose only
Doxycycline
100mg
twice daily
7 days
four times
daily
7 days
contraindicated in
pregnancy
Use in pregnancy
“Test of Cure”
necessary after 3-4
weeks
Erythromycin*
500mg
Neisseria gonorrhoeae, uncomplicated
Drug Name
Dose
Frequency
Comments
Cefixime 400mg
400mg
One dose only
1st choice in
Bedford locality
(unlicensed
indication). Can
be used in
pregnancy.
Ciprofloxacin
500mg
One dose only
1st line choice in
Luton
When treating for Gonorrhoea, GUM recommend that treatment for Chlamydia is included in
regimen
Herpes Simplex (Genital Infection)
Drug Name
Dose
Frequency
Duration
Aciclovir
200mg
five times per
day
5 days
8
Comments
Skin/Soft Tissue Infections
Impetigo
Oral therapy is preferred. You are advised not to use mupirocin (Bactroban) as this should be
reserved for the treatment of MRSA.
Drug Name
Dose
Frequency
Duration
Flucloxacillin
250-500mg
7 days
Erythromycin*
500mg
Topical
Sodium
Fusidate
One
application
four times
daily
two or four
times daily
three to four
times daily
Comments
7 days
5 days
ONLY for small and
localised cases. Topical
use promotes resistance
and should be avoided in
most cases
Cellulitis
Group A haemolytic streptococci (Streptococcus pyogenes) and Staphylococcus aureus are often
both involved. Treat until there has been good clinical response.
Drug Name
Amoxicillin
Plus
Flucloxacillin
Dose
500mg
Co-fluampicil
1-2 caps
Erythromycin*
500mg
250-500mg
Frequency
three times
daily
four times
daily
four times
daily
Duration
10 days
four times
daily
10 days
10 days
10 days
Comments
Amoxicillin and
flucloxacillin
given together
Only one
prescription
charge
For genuine
penicillin allergy
Wound Infections
It is often useful to send a swab, with the site and nature of the wound specified, especially from
a post-operative wound. Commonly due to Staphylococcus aureus.
Drug Name
Flucloxacillin
Dose
250-500mg
Erythromycin*
250-500mg
Frequency
four times
daily
four times
daily
Duration
5 days
Comments
5 days
*Clarithromycin is an acceptable alternative in those unable to tolerate erythromycin.
Contaminated wounds
Lacerations that have become infected and were originally contaminated with soil, manure, or
faeces; puncture wounds; or lacerations that have a significant degree of devitalized tissue.
Ensure wound is appropriately cleansed and current check tetanus status.
Drug Name
Dose
Frequency
Duration
9
Comments
Co-Amoxiclav*
375-625mg
Erythromycin
plus
250-500mg
Metronidazole
400mg
three times a
day
four times
daily
5 days
5 days
three times a
day
5 days
Alternative
regime for
genuine
penicillin
allergy
*If contamination is due to soil/faeces, consider adding in metronidazole 400mg 8 hourly
Leg Ulcers and Pressure Sores
These inevitably become colonised by bacteria. Routine swabs are not indicated. Antibiotic
treatment should be reserved for patients with cellulitis, from whom a wound swab should be taken
and treatment commenced as for cellulitis. Do not treat leg ulcers unless there is clinical evidence
of an infection.
Animal and Human Bites
Pasteurella multocida (animal only) and anaerobes may well be involved.
A swab should be sent. For animal bites, assess rabies risk. For human bites, assess HIV /
Hepatitis B risk.
Drug Name
Dose
Frequency
Duration
Comments
Co-amoxiclav
625mg
three times
daily
5 - 7 days
In severe cases,
consider IV route
for the first dose.
If the patient is genuinely allergic to or intolerant of co-amoxiclav, alternative treatments are
doxycycline plus metronidazole or consult microbiologist. Consider Rabies prophylaxis for bites
from animals in endemic countries and assess risk of blood borne viruses.
Otitis Externa



Antibiotics are often not appropriate and good local hygiene may solve the problem.
Repeated use of topical antibiotics can result in the selection of antibiotic-resistant organisms
including fungi.
Culture of any discharge is valuable at first presentation to guide rational prescribing.
Scabies
Treat all family members of the household, close contacts and sexual contacts simultaneously
Permethrin 5% dermal cream
Available OTC from pharmacies
If the patient is in a residential/nursing home, inform the CCDC on telephone number 01525
636841.
10
Headlice
Treatment is not necessary unless a live louse is found. There is currently no local policy for the
rotation of pesticides. There are two treatment strategies that can be used:
Insecticides: two applications of an insecticide are used 7 days apart (Note: this is different to the
packaging information, which states that a single application is sufficient). Success is checked by
detection combing 2-3 days after the final application. If treatment fails or re-infestation occurs, a
course of a different insecticide is used.
Wet combing: this must be undertaken meticulously to be successful. It must be undertaken
every 4 days for at least 2 weeks. If lice are found on the second, third, or fourth session, it should
be continued until no lice have been seen for three consecutive sessions. Families using this
method must be well motivated because of the time involved.
Dermatophyte Infections
These are chronic infections often requiring prolonged treatment. It is therefore very important to
send appropriate specimens and confirm the diagnosis microbiologically. Should a case fail to
respond to first line therapy, dermatological opinion should be sought. Do not change to another
topical antifungal as they all have the same spectrum of activity.
Scalp (Tinea Capitis)


Take scalp scrapings including hair root. Refer to a dermatologist.
Topical imidazole creams are ineffective.
Drug Name
Dose
Frequency
Duration
Comments
Griseofulvin
0.5-1.0g
once daily
minimum
6-12
weeks
Avoid pregnancy during
and for 1 month after
treatment. Men should
not father children within
6 months of treatment.
(In children
10mg/kg)
Body/Groin/Feet (Tinea Corporis/Cruris/Pedis)

Take skin scrapings.
Drug Name
Dose
Frequency
Duration
Clotrimazole
1 % cream
two to three
times daily
Terbinafine
1 % cream
twice daily
Topical
undecenoic
acid (e.g.
Mycota)
See BNF for
preparations
once or twice
daily
Until 1-2
week after
clinical cure
1 to 2
weeks
4 to 6
weeks
11
Comments
For Tinea Pedis.
Administer for 14
days after
symptomatic
resolution.
Nail (Tinea Unguium)


Many people have long standing fungal infections of their toenails, but many have no
symptoms apart for the change in appearance of the nail. In these instances it may be entirely
appropriate to give no treatment, so as to avoid complications associated with systemic
therapy.
Take nail clippings. Treatment should be started only when results of mycological examination
are available because it is easy to misdiagnose fungal nail infections and the choice of
treatment may be affected by the results.
Drug Name
Dose
Frequency
Duration
Comments
Terbinafine
250mg
once daily
Not yet recommended
for children
Griseofulvin
0.5g –
1.0g
once daily
6 weeks
(fingernails)
or 3 months
(toenails)
6 months
(fingernails)
or 12
months
(toenails)
Children
10mg/kg

Avoid pregnancy during
and for 1 month after
treatment; men should
not father children within
6 months of treatment.
If there is no response, review the diagnosis or seek specialist help.
Herpes zoster / Chicken Pox and Varicella zoster / Shingles

Oral antivirals are not indicated in young (less than 60 years) healthy adults, as such
individuals are unlikely to have severe symptoms and are at very low risk of developing
postherpetic neuralgia. However, oral antiviral treatment should be offered to people
presenting within 72 hours of the shingles rash who are at high risk, e.g. 60 years or older,
have ophthalmic shingles, or are immunocompromised
Ophthalmic zoster -treatment is always indicated with urgent referral to the eye clinic.


Drug Name
Dose
Frequency
Duration
Aciclovir
800mg
five times daily
7 days
Valaciclovir
1g
three times daily 7 days
12
Comments
Licensed for herpes
zoster and for herpes
simplex infections of
the skin and mucous
membranes.
Meningococcal Disease
If Meningococcal septicaemia or meningitis is suspected give benzylpenicillin as a stat dose
immediately whilst admission to hospital is arranged.
Benzylpenicillin
1.2g IV or IM;
In children aged 1 - 9 years 600mg
In children aged < 1 year 300mg
If there is a history of penicillin anaphylaxis, give:
Chloramphenicol
or Cefotaxime
1g IV (aged > 12 years);
In children aged < 12 years 20mg/kg
2g IV or IM (adults);
In children 100mg/kg (max 2g) IV or IM
If there is a history of penicillin anaphylaxis and chloramphenicol or
cefotaxime are unavailable, transfer to hospital immediately.
All forms of meningitis particularly meningococcal meningitis or septicaemia should be notified on
suspicion
to
the
CCDC
at
the
Bedfordshire
Health
Protection Agency on 01525 636841.
Outside normal working hours contact the Bedford Hospital switchboard Tel: (01234) 355122.
Prophylaxis in Meningococcal Disease
Prophylaxis should only be initiated after discussion with the CCDC or Consultant in Public Health
Medicine. Prophylaxis is given to those who had ongoing and continuous contact with the index
case, such as household contacts, to eradicate any carriage. Staff who gave mouth-to-mouth
resuscitation should be given prophylaxis. Please note that the prophylaxis does not offer
protection against the disease. CCDC will decide on the wider public health control measures
where these are required.
Drug Name
Dose
Frequency
Ciprofloxacin
500mg
Single dose
Ceftriaxone
IM
250mg
Single dose
Rifampicin
10mg/kg
(under 1
year
5mg/kg)
Twice daily
Duration
Comments
2 days
1st choice for adults
Not licensed for this
indication
1st choice in pregnancy
Not licensed for this
indication
1st choice for children
13
Gastro-intestinal Infections Virus?
Please note food poisoning is a statutorily notifiable to the CCDC. Stool specimens should be sent
for microbiological examination, which helps in the surveillance of the diseases.
Viral
Viral infections are self-limiting and common.
Bacterial
The commonest bacterial causes are campylobacter, salmonella and shigella spp. Most infections
are self-limiting and do not require antibacterial therapy.
Parasitic
The commonest parasitic causes are giardia sp and cryptosporidium sp. There is no specific
therapy for cryptosporidial diarrhoea.
Giardiasis
Drug Name
Dose
Frequency
Duration
Metronidazole
2g
once daily
3 days
14
Comments
Infestations
Threadworms
Diagnosis can be confirmed by a sellotape slide.
Drug Name
Dose
Frequency
Mebendazole
100 mg
Piperazine/
Sennosides
oral powder
2.5 ml
one dose
only
one dose
only
Repeat after 3 months to 1 year
14 days
Piperazine/
Sennosides
oral powder
5 ml
one dose
only
Repeat after 1 year to 2 years
14 days


Duration
Comments
For aged > 2 years
The whole family should be treated and they should be advised to keep fingernails short, bath
each morning and change bed linen. Do not treat worms during pregnancy.
Washing hands and scrubbing nails before each meal and after each visit to the toilet is
essential. drug treatments
Eye Infections
Most acute superficial infections (conjunctivitis and blepharitis) are often caused by staphylococci
and can be treated topically. Endophthalmitis and keratitis may be bacterial, viral or fungal and
require URGENT referral for specialist management
Drug Name
Dose
Frequency & Duration
Comments
Chloramphenicol
eye drops
One drop
Every three hours for 2
days and then four
times a day for 5 days
Chloramphenicol
Ointment
Apply
small
amount
One drop
Four times a day for 2
days and then twice a
day for 5 days
Twice daily for 7 days
Now available to
purchase from
pharmacies. Avoid
using for more
than 5 days
Ointment
preferred for
blepharitis
Alternative to
chloramphenicol
Fucithalmic eye
drops
15