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 Formulary Chapter 27: Antimicrobial Guide - Full Chapter
27.06  Expand sub section  Eye infections
Blepharitis
Formulary

First line: self-care

Second line: Chloramphenicol 1% ointment BD 6 week trial

Third line: Oxytetracycline* 500 mg BD for 4 weeks then 250 mg BD for 8 weeks OR
Doxycycline* 100 mg OD for 4 weeks then 50 mg OD for 8 weeks

*Warning Avoid in pregnancy

When no antibiotic given advise self-care: lid hygiene including warm compresses, lid massage and scrubs, gentle washing, and avoiding cosmetics.

Second line: topical antibiotics if hygiene measures are ineffective after 2 weeks.

Signs of Meibomian gland dysfunction, or acne rosacea: consider oral antibiotics.

 

 
Link  BNFC Chloramphenicol
   
Conjunctivitis
Formulary

First line: self-care

Second line for bacterial infection: continue self care. Chloramphenicol 0.5% eye drops 2 hourly for 2 days then reduce frequency OR chloramphenicol 1% ointment QDS (or just at night if used with eye drops during the day)

Third line: Fusidic acid 1% gel BD

Treat for 48 hours after resolution

Treat if severe, as most viral or self-limiting. 65% of cases resolve on placebo by day 5

When no antibiotic given advise self-care: bathe or clean eyelids with cotton wool dipped in sterile saline or boiled (cooled) water, to remove crusting. Explain red flags for urgent review and advise the person to seek further help if symptoms persist beyond 7 days.

For neonatal infections: treatment not indicated; advise cleaning only and take a swab for Chlamydia

 
Link  BNFC Chloramphenicol
Link  BNFC Fusidic acid
   
Orbital cellulitis
Formulary
 
Urgent referral to hospital
 
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Amber Recommended  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose and the patientís condition is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patientís dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose and the patientís condition is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patientís dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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