# Acute bacterial conjunctivitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAO Preferred Practice Pattern: Conjunctivitis 2018 · Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662) · DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7) · Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph) - Verified date: 2026-08 ## Verified against - Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662) - DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7) - Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph) - Acute bacterial conjunctivitis - disease-level clinical article (acute-conjunctivitis-clinical.txt) ## Treatment metadata - Chloramphenicol — eye - Tobramycin — eye - Referral & safety-netting (no drug therapy) - Gatifloxacin — eye ## Complete treatment card ```text ACUTE BACTERIAL CONJUNCTIVITIS Sources: AAO Preferred Practice Pattern: Conjunctivitis 2018 · Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662) · DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7) · Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph) Review status: REVIEWED against Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662), DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7), Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph), Acute bacterial conjunctivitis - disease-level clinical article (acute-conjunctivitis-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Eye redness with tearing and discharge, one or both eyes [eye discharge · eye redness] - Eye pain, itching, blurred or lost vision, and light sensitivity may accompany the redness [eye pain · itching · photophobia · redness] - History should cover trauma, prior similar episodes, past treatment, contact lens wear, immune status, and sexual history - Eyelids stuck together on waking points toward a bacterial cause - Lack of itching and no prior conjunctivitis history are predictors of a bacterial cause - Absence of a burning feeling and lack of watery discharge also favor a bacterial cause - Ear symptoms should be asked about, since affected children can have otitis media at the same time SIGNS - what you find (5) - Conjunctival redness and purulent discharge are the textbook exam findings [eye redness · pus] - Thick purulent or mucopurulent discharge is the traditional clue to a bacterial cause, versus a watery discharge in viral or allergic disease [pus] - Crusted or matted eyelashes on exam support a bacterial cause [crusting] - An ear exam with an otoscope is warranted when children report ear symptoms, to check for coexisting middle-ear infection - A full eye exam should check visual acuity and look for corneal involvement TESTS (3) - Routine labs and imaging add little to diagnosing bacterial conjunctivitis - Eye cultures are advised when neonatal gonococcal eye infection is suspected, or heavy purulent discharge raises concern for gonorrhea or chlamydia - Cultures can also be sent for repeat episodes or when treatment has failed IF NOT THIS - what else fits (4) - Viral and allergic conjunctivitis are the main alternatives to consider - Watery discharge with itch points away from bacterial cause, toward allergy or a virus - Ocular trauma can produce a similar picture to bacterial conjunctivitis - Corneal infection and iris inflammation need to be excluded, since they carry real risk of harm Source StatPearls "Bacterial Conjunctivitis" - disease-level clinical article Status traced to the source above 1. CHLORAMPHENICOL [1st line] Adult Instil 0.5% eye drops 1 drop every 2 hours initially, reducing to QID as infection clears x 5 days Peds 2 years and over: As for an adult - indicated from 2 years for acute bacterial conjunctivitis. (Chloramphenicol is broad spectrum antibiotic indicated in both adults and children aged 2 years and over for the treatment of acute bacterial conjunctivitis.) Choice Alternatives. The entry's own rationale names chloramphenicol the broad-spectrum agent of choice in UK and Egyptian practice, and it is the cheaper (3-12 EGP against 6-32). Source Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662) Why Broad-spectrum topical antibacterial of choice in UK/Egyptian practice Caution Avoid long-term use due to rare risk of aplastic anemia. Store eye drops in refrigerator (2-8C). The label gives one drop every 2 hours for the first 48 hours, then every 4 hours, during waking hours only, for a 5-day course. It is licensed from 2 years; below that, and especially in a newborn, treat as a specialist problem. Egypt OPHTAMYCETINE 0.5% EYE DROPS. KAHIRA 2.65 EGP CHLORAMPHENICOL 0.5% EYE DROPS. MEMPHIS 3.50 EGP OPTOCETINE 0.5% EYE DROPS CID 4.00 EGP ISOMIPHENICOL 0.5% EYE DROPS 10 ML MISR 4.50 EGP ISOPTOFENICOL 0.5% EYE DROPS 15 ML RAMEDA > ALCON 9.00 EGP OCUPHENICOL 0.5% EYE DPS. 10 ML ALEXANDRIA 12.00 EGP MIPHENICOL 1% EYE OINT. 5 GM MISR 4.00 EGP EPIPHENICOL 1% EYE OINT. 5 GM EIPICO 7.00 EGP 2. TOBRAMYCIN [1st line] Adult Instil 0.3% ophthalmic solution 1-2 drops into affected eye(s) every 4 hours for 5-7 days (in severe infections, 2 drops every hour until improvement) Peds 3 months and over: 1 drop into affected eye every 4 hours for 5 to 7 days. (Children >2 months: instil 1 drop into affected eye(s) every 4 hours for 5-7 days) Source DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7) Why Effective aminoglycoside option for bacterial conjunctivitis Caution Topical hypersensitivity reactions (eyelid itching, swelling) may occur. Avoid contact lens wear during active eye infection. Prolonged use may result in superinfection with non-susceptible organisms. Egypt SWIXTOBRAM 0.3% EYE DROPS 5 ML CHEMIPHARM 6.50 EGP T GRAND 0.3% EYE DROPS 5 ML DELTA GRAND P... 7.00 EGP TOBRAL 0.3% EYE DROPS 5 ML KAHIRA 7.00 EGP TOBRACTIVA 0.3% EYE DROPS 5 ML EPCI 18.00 EGP AVAZIR 0.3% EYE DROPS 10 ML ORCHIDIA PHAR... 28.00 EGP TOBREX 0.3% EYE DROPS 5 ML NOVARTIS > NO... 32.50 EGP TOBRIN 0.3% EYE.OINT. 5 GM EIPICO 23.00 EGP AVAZIR 0.3% EYE OINT. 5 GM ORCHIDIA PHAR... 26.00 EGP 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Bacterial Conjunctivitis - disease-level clinical article (acute-conjunctivitis- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Instruct contact lens wearers to remove lenses during treatment. 4. GATIFLOXACIN [2nd line] Adult 0.3% solution: 1 drop into the affected eye(s) every 2 hours while awake on days 1 and 2 (maximum 8 times a day), then 1 drop 4 times a day while awake on days 3 to 7. 0.5% solution: 1 drop every 2 hours while awake on day 1 (maximum 8 times a day), then 1 drop 2 to 4 times a day on days 2 to 7 x 7 days Peds The formulary gives a single regimen for adults and children alike - the same drop schedule. No mg/kg dosing applies to eye drops. Source Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph) Why 12 live products, all ophthalmic, and the formulary's only listed indication is bacterial conjunctivitis. Broader Gram-negative cover than chloramphenicol, which matters in a contact-lens wearer where Pseudomonas must be covered. Caution Most acute conjunctivitis is viral and self-limiting - do not prescribe an antibiotic drop reflexively. Reserve a fluoroquinolone drop for contact-lens wearers, for suspected Pseudomonas, or for failure of chloramphenicol - routine use breeds resistance. Pain, photophobia, reduced vision or a corneal opacity is keratitis, not conjunctivitis - refer the same day. Remove contact lenses and do not wear them until the eye is white and the course is finished. Discard the bottle 4 weeks after opening. Never inject ophthalmic solution into the eye. Egypt OCCUBACT 0.3% EYE DPS. 5 ML SIGMA TEC 13.20 EGP GATIGRAND 0.3% EYE DPS. 5 ML DELTA GRAND P... 14.40 EGP GATIPRAM 0.3% EYE DROPS. 5 ML KAHIRA > MODE... 14.40 EGP SOLOGATI 0.3% EYE DPS. 5 ML GRAND PHARMA ... 16.50 EGP GATYXEL 0.3% EYE OINT 5 GM ORCHIDIA PHAR... 25.50 EGP PHARMAGATIN 0.3% EYE DROPS 5 ML RAMEDA > PHAR... 27.00 EGP TYMER 0.3% EYE DROPS 5 ML JAMJOOM PHARM... 66.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)