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 cannot 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)
- had eye surgery or laser treatment in the last 6 months
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 chloramphenicol
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 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 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 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.
Immediate action required: Call 999 or go to A&E now 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
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of chloramphenicol. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card 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.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
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: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
8. Common questions
How does chloramphenicol work?
Chloramphenicol is an antibiotic. It works against many different types of bacteria by stopping them from growing and multiplying.
Can I use chloramphenicol if I wear contact lenses?
If you usually wear contact lenses, do not wear them while you're using chloramphenicol eye drops or ointment.
If you use soft contact lenses, do not wear them for 24 hours after finishing your course of eye drops or ointment.
What's the difference between using chloramphenicol eye drops and ointment?
An ointment is slightly thicker than a cream, so it stays on the eye for longer than eye drops. This means you only need to use it a few times a day, while you'd need to use the eye drops every 2 hours for the first 2 days.
The downside is that it can be hard to see properly after using eye ointment. This can affect your driving, or your ability to carry out your work and other everyday tasks. It's easier to see after using the eye drops.
Your doctor or pharmacist can tell you whether the eye drops or ointment are best for you. They'll take your work and your lifestyle, as well as your infection, into consideration.
Are prescription chloramphenicol eye drops different to the ones you can buy?
The chloramphenicol eye drops - and eye ointment - on sale in pharmacies are exactly the same strength as the ones on prescription. The only difference is in the name and the packaging.
When will I feel better?
For most eye infections, you should notice an improvement within 2 days.
For ear infections, you'll notice improvement within a few days.
What if I don't get better?
Tell your pharmacist or doctor if you don't start feeling better after taking chloramphenicol for a few days. Also tell them if, at any time, you start to feel worse.
Will it reduce my fertility?
There's no firm evidence to suggest that taking chloramphenicol will reduce fertility in either men or women.
However, speak to a pharmacist or doctor before taking it if you're trying to get pregnant.
Will it give me thrush?
No, you're unlikely to get thrush.
Some people get thrush after taking a course of antibiotic tablets. It happens because antibiotics kill the normal harmless bacteria that help to protect you against thrush.
But chloramphenicol ointments and drops only work on where you put them - in your eyes or ears. They don't get into the rest of your body.
Can I drink alcohol with it?
Yes, you can drink alcohol with chloramphenicol.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking chloramphenicol drops or ointment.
Can I drive or ride a bike?
Chloramphenicol shouldn't affect you being able to drive or cycle.
However, if you experience stinging or burning immediately after applying the eye drops, do not drive or operate machinery immediately. Wait until your eyes are comfortable again and your vision is clear.
Ear infections can make you lose your balance. If you're affected, it's best not to drive or ride a bike until you feel back to normal.