A recent paper criticised the use of topical antibiotics for acute infective conjunctivitis,1 with which I would strongly agree. However, there was no mention of an important contraindication to chloramphenicol eye drops: the risk of systematic complications from absorption into the general circulation of the drug through the conjunctival, nasal, and naso-pharyngeal mucosae. That would be expected anyway on obvious logical grounds. Indeed, one should always consider possible systematic effects from any and every topical applications, particularly in children, and pregnant and lactating women. Of course, chloramphenicol is very rarely used systematically because of the risk of toxicity.
As a result of a previous paper,2 I reviewed, in detail, the evidence of systematic toxicity from chloramphenicol eye drops.3 Another very interesting report has recently been published of a patient suffering acute hepatitis probably from these eye drops: the authors also mention a notification to the Committee on Safety of Medicines of two possible cases of hepatitis associated with chloramphenicol, one of which resulted from eye drops in an infant.4
My clinical practice was to prescribe the antiseptic brolene (propamidine isethionate), the active constituent of golden eye drops and ointment, in strong preference to any antibiotics, especially of course chloramphenicol.
Another fundamental argument against antibiotic eye drops is that most cases of conjunctivitis, especially in children, are due to the insusceptible adenovirus,5 the probable explanation for the very small, therapeutically insignificant, effect of chloramphenicol eye drops in ‘acute infective conjunctivitis’.2,6
The authors are also rightly critical of the quite astonishing and deplorable (my words) decision in June 2005 by the UK Medicines and Healthcare products Regulatory Agency to allow chloramphenicol eye drops to be sold ‘over the counter’ without prescription.7
REFERENCES
- 1.David H, Mant D, Scott C, et al. Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis. Br J Gen Pract. 2009;59(569):897–900. doi: 10.3399/bjgp09X473132. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rose PW, Harnden A Bruggerman, et al. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9479):37–43. doi: 10.1016/S0140-6736(05)66709-8. [DOI] [PubMed] [Google Scholar]
- 3.Phillips CI. Risk of systemic toxicity from topical ophthalmic chloramphenicol. Scott Med J. 2008;53(3):54–55. doi: 10.1258/RSMSMJ.53.3.54. [DOI] [PubMed] [Google Scholar]
- 4.Doshi B, Sarkar S. Topical administration of chloramphenicol can induce acute hepatitis. BMJ. 2009;338:b1699. doi: 10.1136/bmj.b1699. [DOI] [PubMed] [Google Scholar]
- 5.Robbie SJ, Qureshi K, Kashani S, et al. Research into management strategies for acute infective conjunctivitis. BMJ. 2006;333(7665):446–447. doi: 10.1136/bmj.333.7565.446-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Everitt HA, Little PS, Smith PWF. A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice. BMJ. 2006;333(7563):321–324. doi: 10.1136/bmj.38891.551088.7C. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Annonymous News. In brief. BMJ. 2005;330(7505):1406. [Google Scholar]