5. EYE INFECTIONS Indication Comment Drug Dose Duration Conjunctivitis Most bacterial conjunctivitis is self-limiting. First choice: infections may be associated with other upper respiratory tract symptoms Topical Chloramphenicol drops: 1 drop For 48 Mild may not need treatment; treat if moderate or severe or not resolving in hourly for 2 days then hours days. 4 (whilst after Consider taking appropriate swabs before initiating treatment, including separate awake) and resolution swabs for Chlamydia if indicated (see below). ointment: at night Pseudomonal infection requires Gentamicin. as risk of severe Suggest referral progressive infection. If ointment used alone then 3-4 times daily Corneal ulcers Refer urgently to the eye Department do not treat with topical antibiotics as Alternative choices: – For 48 this can interfere with subsequent microbiological investigation Fusidic acid (Fucithalmic®) Apply twice each day hours eye drops - only for after Neonatal organisms resolution Neisseria gonorrhoea causes conjunctivitis in the first few days of life and particularly S. aureus Chlamydia trachomatis at around 5-14 days. Urgently refer to Paediatrics; all infants in the first 28 days of life with conjunctivitis, or for same day assessment and management of their conjunctivitis. NB. A simple sticky eye (when are no signs of conjunctival inflammation) does Topical Gentamicin (if drops: 1 drop not usually require specialist assessment. pseudomonas) (if severe); qds when controlled Contact lens associated infections Acanthamoeba spp is a of corneal ulcer primarily in contact lens wearers For contact lens wearers with keratitis, the contact lens should be sent for culture in a sample of contact lens fluid. Urgently refer to eye specialist Chlamydia trachomatis can acute follicular conjunctivitis in adults (usually associated C. trachomatis with sexually transmitted genital infection) and neonates Use specific Chlamydia swabs i.e. urethral or vaginal, and ensure the conjunctiva is swabbed not the discharge from the eye. Refer patient to local eye and STD clinics immediately Herpes simplex virus Refer immediately to eye casualty
5. EYE INFECTIONS Indication Comment Drug Dose Duration Conjunctivitis Most bacterial conjunctivitis is self-limiting. infections may be associated with other upper respiratory tract symptoms Mild may not need treatment; treat if moderate or severe or not resolving in days. Consider taking appropriate swabs before initiating treatment, including separate swabs for Chlamydia if indicated (see below). Pseudomonal infection requires Gentamicin. Suggest referral as risk of severe progressive infection. Corneal ulcers Refer urgently to the eye Department – do not treat with topical antibiotics as this can interfere with subsequent microbiological investigation Neonatal Neisseria gonorrhoea causes conjunctivitis in the first few days of life and Chlamydia trachomatis at around 5-14 days. Urgently refer to Paediatrics; all infants in the first 28 days of life with conjunctivitis, for same day assessment and management of their conjunctivitis. NB. A simple sticky eye (when are no signs of conjunctival inflammation) does not usually require specialist assessment. Contact lens associated infections Acanthamoeba spp is a of corneal ulcer primarily in contact lens wearers For contact lens wearers with keratitis, the contact lens should be sent for culture in a sample of contact lens fluid. Urgently refer to eye specialist Chlamydia trachomatis C. trachomatis can acute follicular conjunctivitis in adults (usually associated with sexually transmitted genital infection) and neonates Use specific Chlamydia swabs i.e. urethral or vaginal, and ensure the conjunctiva is swabbed not the discharge from the eye. Refer patient to local eye and STD clinics immediately Herpes simplex virus Refer immediately to eye casualty First choice: Topical Chloramphenicol Alternative choices: Fusidic acid (Fucithalmic®) eye drops - only for organisms particularly S. aureus or Topical Gentamicin (if pseudomonas) drops: 1 drop for 2 days then 4 hourly (whilst awake) and ointment: at night If ointment used alone then 3-4 times daily Apply twice each day drops: 1 drop (if severe); qds when controlled For 48 hours after resolution For 48 hours after resolution
Doncaster-Bassetlaw-Antimicrobials-Guidelines-for-Primary-Care.docx