Chloramphenicol

1. About chloramphenicol

Chloramphenicol is an antibiotic.

It's mainly used to treat eye infections (such as conjunctivitis) and sometimes ear infections.

Chloramphenicol comes as eye drops or eye ointment. These are available on prescription or to buy from pharmacies.

It also comes as ear drops. These are on prescription only.

The medicine is also given intravenously (directly into a vein) or as capsules. This treatment is for serious infections and is nearly always given in hospital.

2. Key facts

  • Chloramphenicol is safe for most adults and children.
  • For most eye infections, you'll usually start to see an improvement within 2 days of using chloramphenicol.
  • For ear infections, you should begin to feel better after a few days.
  • Your eyes may sting for a short time after using the eye drops or ointment. The ear drops may cause some mild discomfort.
  • Brand names include Chloromycetin, Optrex Infected Eye Drops and Optrex Infected Eye Ointment.

3. Who can and can't take chloramphenicol

Chloramphenicol can be used by most adults and children.

The eye drops and eye ointment are available to buy in pharmacies. For children under 2 years old, you'll need a prescription for chloramphenicol from your doctor.

Chloramphenicol isn't suitable for some people. To make sure chloramphenicol is safe for you, tell your doctor if you have:

  • had an allergic reaction to chloramphenicol or any other medicines
  • a rare illness called aplastic anaemia (when your bone marrow doesn't produce blood cells)

Eye drops or ointment

Before using chloramphenicol, tell you doctor if you're using other eye drops or ointment, or if you normally wear contact lenses. It's also important to speak to your doctor if you have:

  • any problems with your eyesight, or severe eye pain
  • swollen eyes, and a rash on your face or head
  • a cloudy eye
  • unusual looking pupils - irregular size, dilated (bigger than normal), or not reacting to light
  • had a recent eye injury, or something in your eye
  • recently had conjunctivitis
  • dry eye syndrome (when your eyes don't produce enough tears)
  • glaucoma
  • had eye surgery or laser treatment in the last 6 months

Ear drops

Before using chloramphenicol ear drops, tell your doctor if you:

  • have a perforated (burst) eardrum
  • are allergic to polyethylene glycol (an ingredient used in some medicines and cosmetics, and found in some foods)

4. How and when to use it

Chloramphenicol comes in different strengths. How you apply the medicine depends on what you're taking it for and whether you're using the eye drops, eye ointment or ear drops.

If you're using 0.5% chloramphenicol eye drops, put one drop into the affected eye every 2 hours (during waking hours) for the first 2 days. Then every 4 hours for the next 3 days, or as your doctor advises.

If you're using 1% chloramphenicol eye ointment, apply it to the affected eye every 3 hours (during waking hours). Do this 3 to 4 times a day, or as your doctor advises.

With more severe infections, your doctor may recommend using eye ointment at bedtime and eye drops during the day. This is because the ointment sticks to the surface of the eye and eyelid and works while you sleep. The eye drops allow you to get on with your day as normal, as they don't affect your eyesight.

If you're using 5% or 10% chloramphenicol ear drops, put 3 drops into the affected ear 2 to 3 times a day, or as your doctor advises.

To use the medicine:

  • always wash your hands before (and after) using chloramphenicol - this prevents you from passing the infection to the other eye or ear
  • remove the cap just before using your medicine and replace it as soon as you've finished
  • do not touch the nozzle of the bottle or tube with your fingers
  • make sure the nozzle doesn't touch your eye or ear, or your skin
  • use a mirror to help you see what you are doing
  • tilt your head back or to the side to put drops in your eyes or ears

How to apply the eye drops

Gently pull down your lower eyelid with a clean finger and tilt your head back. Hold the bottle over your eye and allow a single drop to fall into the space between your lower lid and your eye. Close your eye for a few minutes. Wipe away any extra liquid with a clean tissue.

How to apply the eye ointment

Gently pull down your lower eyelid with a clean finger and tilt your head back. Hold the tube with the nozzle close to your eye and gently squeeze about 1 centimetre of ointment into the space between your lower lid and your eye. Close your eye for a few minutes.

How to apply the ear drops

Tilt your head and bring the tube up to the affected ear, with the nozzle close to your ear hole. Squeeze the drops into your ear. If you can, lie down for at least 10 minutes afterwards. Turn your head to one side, so your affected ear is towards the ceiling. After this, put some cotton wool in your ear.

How long to use it for

Eye drops - use the drops until the eye appears normal and for 2 days afterwards. Do not use them for more than 5 days, unless your doctor tells you to. This is because your eyes can become more sensitive or you could get another eye infection.

Eye ointment - use the ointment until the eye appears normal and for 2 days afterwards. Do not use it for more than a week, unless your doctor tells you to.

Ear drops - use the drops for up to a week. Avoid using the medicine for longer than this unless your doctor tells you to. This is because your ears can become more sensitive or you could get another ear infection.

When you've finished your treatment, throw away any leftover eye drops, eye ointment or ear drops.

What if I forget to take it?

If you forget to take a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

What if I take too much?

Don't worry if a few more drops of chloramphenicol accidentally fall into your eye or ear, or if you accidentally apply more of the ointment than you meant to.

If you or your child swallow chloramphenicol ointment or drops, seek medical attention.

5. Side effects

Like all medicines, chloramphenicol can cause side effects, although not everyone gets them.

Common side effects

These common side effects happen in more than 1 in 100 people.

Chloramphenicol eye drops or ointment can cause stinging or burning in your eye. This happens straight after using the eye drops or ointment and only lasts for a short time. Do not drive or operate machinery until your eyes feel comfortable again and your vision is clear.

Chloramphenicol ear drops can cause mild stinging, irritation, burning or itching in your ear. If the skin around your ear becomes red and irritated, tell your doctor. This is a sign of dermatitis and your doctor may recommend some different antibiotic ear drops for you.

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Call a doctor straight away if you:

  • bruise more easily
  • get infections more easily
  • feel especially tired or weak

These can be signs of aplastic anaemia, a rare condition where your bone marrow fails to produce blood cells normally. This is very unlikely to happen if you're using chloramphenicol eye drops, ointment or ear drops. There's a greater risk of aplastic anaemia when chloramphenicol is given intravenously (directly into a vein).

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to chloramphenicol.

Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

These are not all the side effects of chloramphenicol. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. Pregnancy and breastfeeding

If you're pregnant or breastfeeding, talk to your doctor or pharmacist before using chloramphenicol.

Chloramphenicol eye drops aren't generally recommended if you're pregnant. This is because there isn't enough research into using them during pregnancy. Speak to your doctor about what's right for you and your baby.

For more information about how chloramphenicol can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

Chloramphenicol and breastfeeding

Avoid using chloramphenicol if you're breastfeeding, especially if your baby was born prematurely, or if there's a family history of any sort of blood disorder, including aplastic anaemia.

Doctors only recommend using chloramphenicol while breastfeeding if the benefits outweigh the risks. For some women with serious infections, treatment with chloramphenicol may be the best option. For others, your doctor may recommend a different type of antibiotic.

Talk to your doctor about what's right for you and your baby.

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

7. Cautions with other medicines

There are some medicines that don't mix well with chloramphenicol.

Tell your doctor if you're taking (or have recently taken) these medicines before you start using chloramphenicol:

  • medicines for cancer
  • medicines for the immune system such as azathioprine (prescribed for rheumatoid arthritis, Crohn's disease, ulcerative colitis, or if you've had a kidney transplant)

Mixing chloramphenicol with herbal remedies and supplements

There are no known problems with taking herbal remedies and supplements alongside chloramphenicol.

Important

For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

8. Common questions

Related conditions

Page last reviewed: 06/12/2018
Next review due: 06/12/2021