Keratitis

Preferred 

ciprofloxacin 0.3% eye drops. Administer: 

• hourly day and night for 48 hours  
• THEN hourly, day-time only for 72 hours  
• THEN 6-hourly until resolution. 

Alternative (including if preservative free preparation is required) 

levofloxacin preservative free eye drops (0.5%). Administer: 

• hourly (day and night) for 48 hours 
• THEN 2-hourly, day-time only for 72 hours 
• THEN 6-hourly until resolution (typically less than 28 days) 

Including cases with a complicated or poor ocular surface.   

Consider admitting patient. Reasons for admission include severe ulcer, high-risk case, difficulty instilling drops, poor compliance with drops.  

Preferred 

levofloxacin preservative free eye drops (0.5%). Administer hourly (day and night) until review

AND cyclopentolate eye drops 1% tds until review   

AND ciprofloxacin* 750mg po bd (if adjacent to limbus) until review  

AND Oral NSAID 

For MRSA positive patients: ADD chloramphenicol eye drops (0.5%) hourly, day and night until review.  

DO NOT prescribe steroids unless organism is known. Steroids should not be prescribed for fungal, viral and acanthamoeba infections.  

*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including ciprofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.

Clinical failure/ second line therapy 

The following antibiotic eye drops can be used according to sensitivity results or can be used in case of problems with availability of first line agents. 

gentamicin eye drops, preserved or preservative free (1.5%) one drop every hour, day and night until review 

AND  

cefuroxime eye drops, preservative free (5%), every hour day and night until review  

Taper according to severity, until resolution. 

See Neisseria Conjunctivitis

Preferred 

Polyhexamethylene Biguanide (PHMB) eye drops (0.06%) hourly, day and night for 48 hours, then reduce as directed by ophthalmology as condition improves. 

AND  

Propamidine (Brolene^®) eye drops qds. Reduce frequency as condition improves. (Minimum 3 months treatment.) 

Preferred  

Natamycin eye drops (5%). Administer: 

• Hourly, day and night for 48 hours 
• THEN hourly, day-time only until epithelium heals   
• THEN qds for 4 weeks after epithelium heals.  

Alternative

Amphotericin eye drops (0.15%). Administer: 

• Hourly, day and night for 48 hours 
• THEN hourly, day-time only until epithelium heals   
• THEN qds for 4 weeks after epithelium heals.  

If Scleral or anterior chamber involved 

ADD voriconazole po. 

For patients 40kg or more: voriconazole 400mg bd po for 24 hours then voriconazole 200mg bd po for 13 days. 

For patients less than 40kg: voriconazole 200mg bd po for 24 hours then voriconazole 100mg bd po for 13 days.  

LFTs should be taken prior to treatment.  

Voriconazole trough levels should be taken 5-7 days post therapy initiation. See Antifungal Therapeutic Drug Monitoring

If fungal endophthalmitis is suspected, see Endophthalmitis guideline in the Fungal Endophthalmitis section.