infectious

Acute bacterial conjunctivitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

AAO Preferred Practice Pattern: Conjunctivitis 2018 · Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662) · DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7) · Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph)

Verified against4 documents

Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662)
DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7)
Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph)
Acute bacterial conjunctivitis - disease-level clinical article (acute-conjunctivitis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

Eye redness with tearing and discharge, one or both eyes [eye discharge · eye redness]
Eye pain, itching, blurred or lost vision, and light sensitivity may accompany the redness [eye pain · itching · photophobia · redness]
History should cover trauma, prior similar episodes, past treatment, contact lens wear, immune status, and sexual history
Eyelids stuck together on waking points toward a bacterial cause
Lack of itching and no prior conjunctivitis history are predictors of a bacterial cause
Absence of a burning feeling and lack of watery discharge also favor a bacterial cause
Ear symptoms should be asked about, since affected children can have otitis media at the same time

Signs — what you find (5)

Conjunctival redness and purulent discharge are the textbook exam findings [eye redness · pus]
Thick purulent or mucopurulent discharge is the traditional clue to a bacterial cause, versus a watery discharge in viral or allergic disease [pus]
Crusted or matted eyelashes on exam support a bacterial cause [crusting]
An ear exam with an otoscope is warranted when children report ear symptoms, to check for coexisting middle-ear infection
A full eye exam should check visual acuity and look for corneal involvement

Tests (3)

Routine labs and imaging add little to diagnosing bacterial conjunctivitis
Eye cultures are advised when neonatal gonococcal eye infection is suspected, or heavy purulent discharge raises concern for gonorrhea or chlamydia
Cultures can also be sent for repeat episodes or when treatment has failed

If not this — what else fits (4)

Viral and allergic conjunctivitis are the main alternatives to consider
Watery discharge with itch points away from bacterial cause, toward allergy or a virus
Ocular trauma can produce a similar picture to bacterial conjunctivitis
Corneal infection and iris inflammation need to be excluded, since they carry real risk of harm

SourceStatPearls "Bacterial Conjunctivitis" - disease-level clinical article

Presentation findings are traced to the source above.

CHLORAMPHENICOL

1st line

Formeye

Adult dose and duration

Instil 0.5% eye drops 1 drop every 2 hours initially, reducing to QID as infection clears x 5 days

Paediatric dose

(Chloramphenicol is broad spectrum antibiotic indicated in both adults and children aged 2 years and over for the treatment of acute bacterial conjunctivitis.)

Dose by age
2 years and over:	As for an adult - indicated from 2 years for acute bacterial conjunctivitis.

Choice

Alternatives. The entry's own rationale names chloramphenicol the broad-spectrum agent of choice in UK and Egyptian practice, and it is the cheaper (3-12 EGP against 6-32).

Dose source

Chloramphenicol 0.5% w/v Antibiotic Eye Drops SmPC section 4.2 (eMC product 9662)

Why

Broad-spectrum topical antibacterial of choice in UK/Egyptian practice

Cautions

Avoid long-term use due to rare risk of aplastic anemia.
Store eye drops in refrigerator (2-8C).
The label gives one drop every 2 hours for the first 48 hours, then every 4 hours, during waking hours only, for a 5-day course. It is licensed from 2 years; below that, and especially in a newborn, treat as a specialist problem.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OPHTAMYCETINE 0.5% EYE DROPS.	KAHIRA	2.65 EGP
CHLORAMPHENICOL 0.5% EYE DROPS.	MEMPHIS	3.50 EGP
OPTOCETINE 0.5% EYE DROPS	CID	4.00 EGP
ISOMIPHENICOL 0.5% EYE DROPS 10 ML	MISR	4.50 EGP
ISOPTOFENICOL 0.5% EYE DROPS 15 ML	RAMEDA > ALCON	9.00 EGP
OCUPHENICOL 0.5% EYE DPS. 10 ML	ALEXANDRIA	12.00 EGP
MIPHENICOL 1% EYE OINT. 5 GM	MISR	4.00 EGP
EPIPHENICOL 1% EYE OINT. 5 GM	EIPICO	7.00 EGP

TOBRAMYCIN

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Formeye

Adult dose and duration

Instil 0.3% ophthalmic solution 1-2 drops into affected eye(s) every 4 hours for 5-7 days (in severe infections, 2 drops every hour until improvement)

Paediatric dose

(Children >2 months: instil 1 drop into affected eye(s) every 4 hours for 5-7 days)

Dose by age
3 months and over:	1 drop into affected eye every 4 hours for 5 to 7 days.

Dose source

DailyMed Tobramycin Ophthalmic Solution 0.3% Package Insert (SetID 8f244ffb-14d2-45e3-9993-9c865f80b2a7)

Why

Effective aminoglycoside option for bacterial conjunctivitis

Cautions

Topical hypersensitivity reactions (eyelid itching, swelling) may occur.
Avoid contact lens wear during active eye infection.
Prolonged use may result in superinfection with non-susceptible organisms.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
SWIXTOBRAM 0.3% EYE DROPS 5 ML	CHEMIPHARM	6.50 EGP
T GRAND 0.3% EYE DROPS 5 ML	DELTA GRAND PHARMA	7.00 EGP
TOBRAL 0.3% EYE DROPS 5 ML	KAHIRA	7.00 EGP
TOBRACTIVA 0.3% EYE DROPS 5 ML	EPCI	18.00 EGP
AVAZIR 0.3% EYE DROPS 10 ML	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	28.00 EGP
TOBREX 0.3% EYE DROPS 5 ML	NOVARTIS > NOVARTIS SCIENTIFIC OFFICE	32.50 EGP
TOBRIN 0.3% EYE.OINT. 5 GM	EIPICO	23.00 EGP
AVAZIR 0.3% EYE OINT. 5 GM	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	26.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Bacterial Conjunctivitis - disease-level clinical article (acute-conjunctivitis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Instruct contact lens wearers to remove lenses during treatment.

GATIFLOXACIN

2nd line

Formeye

Adult dose and duration

0.3% solution: 1 drop into the affected eye(s) every 2 hours while awake on days 1 and 2 (maximum 8 times a day), then 1 drop 4 times a day while awake on days 3 to 7. 0.5% solution: 1 drop every 2 hours while awake on day 1 (maximum 8 times a day), then 1 drop 2 to 4 times a day on days 2 to 7 x 7 days

Paediatric dose

The formulary gives a single regimen for adults and children alike - the same drop schedule. No mg/kg dosing applies to eye drops.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (gatifloxacin monograph)

Why

12 live products, all ophthalmic, and the formulary's only listed indication is bacterial conjunctivitis. Broader Gram-negative cover than chloramphenicol, which matters in a contact-lens wearer where Pseudomonas must be covered.

Cautions

Most acute conjunctivitis is viral and self-limiting - do not prescribe an antibiotic drop reflexively.
Reserve a fluoroquinolone drop for contact-lens wearers, for suspected Pseudomonas, or for failure of chloramphenicol - routine use breeds resistance.
Pain, photophobia, reduced vision or a corneal opacity is keratitis, not conjunctivitis - refer the same day.
Remove contact lenses and do not wear them until the eye is white and the course is finished.
Discard the bottle 4 weeks after opening.
Never inject ophthalmic solution into the eye.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OCCUBACT 0.3% EYE DPS. 5 ML	SIGMA TEC	13.20 EGP
GATIGRAND 0.3% EYE DPS. 5 ML	DELTA GRAND PHARMA	14.40 EGP
GATIPRAM 0.3% EYE DROPS. 5 ML	KAHIRA > MODERN OFFICE FOR IMPORT	14.40 EGP
SOLOGATI 0.3% EYE DPS. 5 ML	GRAND PHARMA > CITY PHARMA	16.50 EGP
GATYXEL 0.3% EYE OINT 5 GM	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	25.50 EGP
PHARMAGATIN 0.3% EYE DROPS 5 ML	RAMEDA > PHARMA MEDICA	27.00 EGP
TYMER 0.3% EYE DROPS 5 ML	JAMJOOM PHARMACEUTICALS	66.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.