Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).

• Eye drops should be used in preference to ointment if other eye drops are being used concurrently (e.g. for glaucoma).
• When two different eye-drop preparations are used at the same time of day, an interval of at least 5 minutes should be left between application of the two types. This will help prevent any dilution and overflow that may occur if application of one preparation immediately follows another.
• Contact lenses should not be used during treatment with topical antibiotics, or if untreated infection is present. Soft contact lenses should be avoided until at least 24 hours after treatment has been completed. In the rare circumstance of this being unavoidable, preservative–free drops should be used, as some preservatives, particularly benzalkonium chloride, accumulate in soft contact lenses and cause irritation. Eye ointment should not be used when contact lenses are worn.
• Transient blurring of vision can occur with eye drops and people should be warned not to drive or operate machinery unless their vision is clear.
• If symptoms get worse despite treatment with a topical antibiotic, advise the person to seek medical advice.

[ABPI Medicines Compendium, 2001; ABPI Medicines Compendium, 2008; ABPI Medicines Compendium, 2007b; ABPI Medicines Compendium, 2007a; BNF 54, 2007]

• Topical chloramphenicol has a relatively broad spectrum of action against most Gram-positive and Gram-negative bacteria, and there is little evidence of bacterial resistance to it.
• If symptoms resolve within the first 5 days of treatment, continue chloramphenicol for 48 hours afterwards.

[ABPI Medicines Compendium, 2008; ABPI Medicines Compendium, 2007b; ABPI Medicines Compendium, 2007a; BNF 54, 2007]

• Do not use topical chloramphenicol:
• In people who have experienced myelosuppression during previous exposure to chloramphenicol.
• In people who have a blood dyscrasia, or who have a family history of blood dyscrasias.
• Concurrently with other myelotoxic drugs.
• In pregnant or breastfeeding women, as its safety has not been established.
• For prolonged periods, since it may increase the likelihood of sensitization and resistance.

[ABPI Medicines Compendium, 2008; ABPI Medicines Compendium, 2007b; ABPI Medicines Compendium, 2007a; BNF 54, 2007]

• Adverse effects are usually minor, such as transient stinging or a burning sensation in the eye.
• Aplastic anaemia and bone marrow depression is extremely rare, and concerns about the increased risk of this adverse effect have not been proven.

[ABPI Medicines Compendium, 2008; ABPI Medicines Compendium, 2007b; ABPI Medicines Compendium, 2007a; BNF 54, 2007]

• Topical fusidic acid is active against Gram-positive bacteria, especially Staphylococcus aureus, and acquired resistance within Gram-positive species is low.
• Administration of fusidic acid is required only twice a day, which may be of benefit for young children or elderly people who require assistance in applying eye drops.
• If symptoms resolve within the first 5 days of treatment, continue fusidic acid for 48 hours afterwards.

[ABPI Medicines Compendium, 2001; BNF 54, 2007]

• Adverse effects are usually minor, such as transient stinging or a burning sensation in the eye.

[ABPI Medicines Compendium, 2001; BNF 54, 2007]