West of Scotland Formulary
NHS Scotland

Bacterial conjunctivitis

The regional formulary will not cover all eventualities for infections medicines choices. As with any condition; patient specific factors and sensitivities need to be considered. Please consider this regional formulary advice alongside any relevant local Board guidelines.

For general guidance on administration of drugs to the eye and on control of microbial contamination of eye drops, please see the ‘General information on eye drops’ recommendations.

NICE CKS: Conjunctivitis - infective

Treatment of bacterial conjunctivitis

No treatment (see prescribing notes).

Chloramphenicol
Chloramphenicol 0.5% eye drops

1 drop usually every 2 hours for 2 days, then every 6 hours for up to a week, continue for 48 hours after resolution.

Chloramphenicol 1% eye ointment

Usually every 6-8 hours daily, or at night (with drops during the day). Course length up to 1 week, continue for 48 hours after resolution.

Fusidic acid is substantially more expensive than chloramphenicol formulations. Only use if swab for culture and sensitivities identifies that isolate is susceptible or chloramphenicol has already been tried or is contra-indicated.

Fusidic acid
Fusidic acid 1% modified-release eye drops

One drop every 12 hours. Course length up to 1 week, continue for 48 hours after resolution.

Prescribing Notes:

  • Most cases of acute bacterial conjunctivitis are self-limiting and resolve within 5-7 days without treatment. Treat with topical antibiotics if severe. A delayed treatment strategy may be appropriate - advise the person to initiate topical antibiotics if symptoms have not resolved within 3 days.
  • Self-care is the recommended first line treatment for conjunctivitis. Bathe clean eyelids with cotton wool dipped in sterile saline or boiled and cooled water to remove crusting.
  • Fusidic acid does not give Gram-negative cover.
  • Chloramphenicol ointment and drops to treat bacterial conjunctivitis are available via the Pharmacy First service, or to purchase from community pharmacies. The pharmacist will assess the patient to ascertain suitability before deciding whether to supply the medicine.
  • Refer to NICE CKS guidance on infective conjunctivitis for advice on when to refer to ophthalmology and for conjunctivitis in contact lens wearers.
  • Antibacterials are not helpful in managing viral conjunctivitis. Viral (non-herpetic) conjunctivitis usually resolves within 1-2 weeks without treatment.
  • Simple lubricants are often helpful for comfort.
  • Bacterial keratitis and cellulitis require treatment by or under instruction of a consultant ophthalmologist.

History Notes

30/07/2026

Regional formulary chapter launched.