BNF for Children 2011-2012

BNFC 2011–2012 11.3.1 Antibacterials 519Other antibacterial eye drops may be prepared asepticallyin a specialist manufacturing unit from materialsupplied for injection, see section 11.8.Neonates Antibacterial eye drops are used to treatacute bacterial conjunctivitis in neonates (ophthalmianeonatorum); where possible the causative microorganismshould be identified. Chloramphenicol orneomycin eye drops are used to treat mild conjunctivitis;more serious infections also require a systemicantibacterial. Failure to respond to initial treatmentrequires further investigation; chlamydial infection isone of the most frequent causes of neonatal conjunctivitisand should be considered.Gonococcal eye infections are treated with a single-doseof parenteral cefotaxime or ceftriaxone. Chlamydialeye infections should be managed with oral erythromycin.Gentamicin eye drops together with appropriatesystemic antibacterials are used in the treatment ofpseudomonal eye infections; high-strength gentamicineye drops (1.5%) [unlicensed] are available for severeinfections.With corticosteroids Many antibacterial preparationsalso incorporate a corticosteroid but such mixturesshould not be used unless a patient is under closespecialist supervision. In particular they should not beprescribed for undiagnosed ‘red eye’ which is sometimescaused by the herpes simplex virus and may bedifficult to diagnose (section 11.4).Administration Frequency of application depends onthe severity of the infection and the potential for irreversibleocular damage; antibacterial eye preparationsare usually administered as follows.Eye drops. Apply 1 drop at least every 2 hours in severeinfection then reduce frequency as infection is controlledand continue for 48 hours after healing. Forless severe infection 3–4 times daily is generally sufficient.Eye ointment. Apply either at night (if eye drops usedduring the day) or 3–4 times daily (if eye ointment usedalone).CHLORAMPHENICOLSide-effects transient stinging; see also notes aboveIndication and doseSee notes aboveSingle useMinims c Chloramphenicol (Bausch & Lomb) AEye drops, chloramphenicol 0.5%. Net price 20 0.5 mL = £9.17CIPROFLOXACINCautions not recommended for children under 1 yearPregnancy manufacturer advises use only if potentialbenefit outweighs riskBreast-feeding manufacturer advises cautionSide-effects local burning and itching; lid margincrusting; hyperaemia; taste disturbances; cornealstaining, keratitis, lid oedema, lacrimation, photophobia,corneal infiltrates; nausea and visual disturbancesreportedLicensed use eye ointment not licensed for use inchildren under 1 yearIndication and doseSuperficial bacterial infectionsSee notes aboveCorneal ulcerApply eye drops throughout day and night, day 1apply every 15 minutes for 6 hours then every 30minutes, day 2 apply every hour, days 3–14 applyevery 4 hours (max. duration of treatment 21 days)Apply eye ointment throughout day and night;apply 1.25 cm ointment every 1–2 hours for 2 daysthen every 4 hours for next 12 daysCiloxan c (Alcon) AOphthalmic solution (= eye drops), ciprofloxacin (ashydrochloride) 0.3%. Net price 5 mL = £4.70Excipients include benzalkonium chlorideEye ointment, ciprofloxacin (as hydrochloride) 0.3%.Net price 3.5 g = £5.22FUSIDIC ACIDIndication and doseSee notes above and under preparation belowFucithalmic c (LEO) AEye drops, m/r, fusidic acid 1% in gel basis (liquifieson contact with eye). Net price 5 g = £1.96Excipients include benzalkonium chloride, disodium edetateDoseApply twice daily11 EyeChloramphenicol (Non-proprietary) AEye drops, chloramphenicol 0.5%. Net price 10 mL =£2.05Eye ointment, chloramphenicol 1%. Net price 4 g =£2.04Note Chloramphenicol 0.5% eye drops (max. pack size 10 mL)and 1% eye ointment (max. pack size 4 g) can be sold to thepublic for treatment of acute bacterial conjunctivitis in childrenover 2 years; max. duration of treatment 5 daysChloromycetin c (Goldshield) ARedidrops (= eye drops), chloramphenicol 0.5%. Netprice 5 mL = £1.65; 10 mL = 90pExcipients include phenylmercuric acetateOphthalmic ointment (= eye ointment), chloramphenicol1%. Net price 4 g = £1.08GENTAMICINIndication and doseSee notes aboveGenticin c (Amdipharm) ADrops (for ear or eye), gentamicin 0.3% (as sulphate).Net price 10 mL = £2.13Excipients include benzalkonium chlorideGentamicin (Non-proprietary) AEye drops, gentamicin 1.5%, 10 mL, available as amanufactured special from Moorfields Eye Hospital,see also ‘special-order’ manufacturers or specialistimporting companies, p. 809