Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Recommended first-line antibiotic treatment for bacterial conjunctivitis in both adults and children:
- Topical antibiotics are generally not routinely prescribed as most cases are self-limiting and resolve within 5–7 days without treatment.
- If treatment is required due to severity or need for rapid symptom resolution, chloramphenicol 0.5% eye drops are recommended as first-line: apply 1 drop every 2 hours for 2 days, then reduce frequency to 3-4 times daily depending on severity, continuing until 48 hours after infection clears.
- Alternatively, chloramphenicol 1% ointment can be used, applied 3-4 times daily until 48 hours after infection clears.
- Fusidic acid 1% eye drops is considered a second-line option, applied 1 drop twice daily until 48 hours after infection clears.
- There is no clinical evidence to suggest superiority of any particular antibiotic, but Public Health England recommends chloramphenicol as second-line and fusidic acid as third-line due to spectrum of activity.
These recommendations apply from age 1 month onwards and are consistent for both adults and children.
For contact lens wearers, antibiotics effective against Gram-negative organisms (e.g., aminoglycosides like gentamicin or quinolones) are preferred, but this is a special circumstance.
Patient education and delayed prescribing strategies (starting antibiotics if symptoms persist beyond 3 days) are also advised.
NICE CKS