Antibiotic treatment

Despite common expectations, antibiotics are required in only a minority of cases. Their use should generally be reserved for situations where symptoms are more severe, discharge is persistently purulent, symptoms fail to improve after several days, or discomfort significantly
interferes with daily activities.

Sometimes, safeguarding or childcare considerations may also influence management.

Chloramphenicol (as 0.5% eye drops) remains the most commonly supplied antibiotic under PGDs. Its broad spectrum of activity, low resistance rates and minimal systemic absorption make it suitable for short-term use in uncomplicated bacterial conjunctivitis.

Patient group directions typically specify an initial period of more frequent dosing, followed by a reduced frequency once improvement is seen. In practice, this usually involves instilling one drop every two hours while awake for the first 48 hours, followed by one drop every four hours thereafter. 

Treatment is continued for a short period after symptoms resolve, with a maximum total duration of around five days. This stepped approach aims to achieve early symptom control while limiting unnecessary antibiotic exposure.

Pharmacists must always follow the precise dosing instructions and duration outlined in their locally authorised PGD.