Experiences with
Chloramphenicol

Chloramphenicol is an antibiotic medicine.

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

Who can use chloramphenicol

Chloramphenicol can be used by most adults and children including babies.

The eye drops and eye ointment are available to buy in pharmacies for use in adults and children aged 2 years and over.

For children under 2 years, you'll need a prescription for chloramphenicol from your doctor.

Chloramphenicol is not suitable for everyone. To make sure it's safe for you, tell your doctor if:

you have ever had an allergic reaction to chloramphenicol or any other medicine
you or anyone in your family has ever had a rare condition called aplastic anaemia (when your bone marrow does not produce blood cells)

Who may not be able to use 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 do not produce enough tears)
glaucoma
had eye surgery or laser treatment in the last 6 months

Who may not be able to use ear drops

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

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

Dosage

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

To use all types of chloramphenicol:

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 eye dropper or tube with your fingers
make sure the nozzle does not touch your eye or ear, or your skin
use a mirror to help you see what you're doing
tilt your head back or to the side to put drops in your eyes or ears

When you've finished your treatment, throw away any leftover medicine.

How to use eye 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.

Tilt your head back and gently pull down your lower eyelid with a clean finger. 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.

For more severe infections, your doctor may recommend using ointment at bedtime and eye drops during the day. This is because the ointment works better while you sleep. The eye drops allow you to get on with your day as normal, as they do not affect your eyesight.

How to use eye ointment

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.

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.

With more severe infections, your doctor may recommend using eye ointment at bedtime. This is because the ointment sticks to the surface of the eye and eyelid and works while you sleep.

How to use ear drops

If you're using 5% or 10% chloramphenicol ear drops, put 3 or 4 drops into the affected ear 2 to 3 times a day, or as your doctor advises.

Tilt your head and bring the tube up to the affected ear, with the dropper 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 for 5 days, even if your eye seems better.

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 5 days, unless your doctor tells you to.

Ear drops

Use the drops for up to 1 week. Do not use 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.

If you forget to use it

If you forget to use chloramphenicol drops or ointment, use or apply it as soon as you remember. Then continue to use it at the usual time.

If you often forget to use your chloramphenicol, 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.

If you use too much

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

you or your child swallow chloramphenicol ointment or drops

Go to 111.nhs.uk or call 111. If you need advice for a child under the age of 5 years, call 111.

If 111 advise you to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the leaflet that came with your drops or ointment, plus any remaining medicine with you.

Common side effects

These common side effects of chloramphenicol happen in more than 1 in 100 people. There are things you can do to help cope with them:

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

Call your doctor or contact 111 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).

Go to 111.nhs.uk or call 111. If you're calling for a child under 5 years, call 111.

Serious allergic reaction

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

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

Chloramphenicol and pregnancy

Chloramphenicol eye treatments and ear drops can be used in pregnancy. Only tiny amounts are absorbed into the bloodstream and it's not thought that these can harm your baby.

Talk to your doctor or pharmacist about the best treatment for you. This will depend on how bad the infection is and whether there are other medicines that might be more suitable.

If your baby was born well and healthy it is OK to use chloramphenicol eye treatment and ear drops while breastfeeding.

If there is a family history of any sort of blood disorder, including aplastic anaemia, you may be advised not to use chloramphenicol.

It's not yet known how much chloramphenicol passes into breast milk, but it's likely to be a tiny amount for preparations used for the eyes and ears. However, until we know more about chloramphenicol in breastfeeding, other medicines might be recommended.

Wash your hands thoroughly before picking up your baby.

If you notice your baby has a stomach upset, seems unusually unsettled, has a rash, or seems an unusual colour, talk to your health visitor, midwife or doctor as soon as possible.

Chloramphenicol and fertility

There's no evidence to suggest that using chloramphenicol reduces fertility in either men or women.

Cautions with other medicines

There are some medicines that do not mix well with chloramphenicol.

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

medicines for cancer such as cyclophosphamide
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)

There's not enough information to say that complementary medicines and herbal remedies are safe to take with chloramphenicol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.