Chloramphenicol eye-drops

Blepharitis is a topical inflammation of the eyelid margins that should be treated using topical antibacterial agents. Gentamicin eye ointment is preferred to the fusidic acid drops since the ointment is a better formulation to be used where the condition involves the eyelid margins. Chloramphenicol eye drops is the third option since it is an antibiotic with a wider spectrum of activity. A combination of corticosteroid and antibiotic is not recommended because of the side-effects associated with the steroid. The use of oral tablets is not usually recommended since blepharitis can easily be managed with topical drops. The use of dexamethasone eye drops, monotherapy steroid, could clear the inflammation but mask persistence of infection. 

Infective conjunctivitis is usually a self-limiting, non-harmful condition, with spontaneous symptom resolution within 2-14 days that is not dependent upon treatment. Within a pharmacy setting, it may be appropriate to treat any superficial infective conjunctivitis, in the absence of any requirement to refer a patient to a doctor, with chloramphenicol eye drops, which current clinical opinion suggests as the first-line choice, as sometimes it is difficult clinically to... 

Another drug preparation, for which the storage in brown glass containers is problematic, is chloramphenicol eye drops. After short periods of exposure to UV and VIS radiation, toxic degradation products and significant losses in drug content have been reported (6). 

Figure 14 Photodegradation of chloramphenicol eye drops FNA depending on the container. (A) White glass ampoule, (B) LD-polyethylene container, (C) brown glass container, (D) LD-polyethylene container, white, opaque, (E) LD-polyethylene container in the carton. ( ) 6 weeks diffuse daylight, ( ) 6 weeks sunlight. Source From Ref. 6.

On exposure to sunlight, under in vivo-related circumstances relevant to the eye under treatment, p-nitrobenzaldehyde, p-nitrobenzoic acid, and p-nitrosobenzoic acid were found (9) in chloramphenicol eye drops. The amount of p-nitrosobenzoic acid foimd, represented 45 mol% of the initial amount of chloramphenicol. Patients should be informed if photoprotective storage of these eye drops is necessary, and that the intense photon exposure of the eye after administration of chloramphenicol eye drops should be avoided. 

The first death resulting from bone marrow aplasia induced by chloramphenicol eye-drops was described in 1955 (17). Chloramphenicol causes two types of bone marrow damage (18). 

For many years it had been said that there were no cases of aplastic anemia after parenteral administration of chloramphenicol however, a few cases of aplastic anemia have been reported (35). There have also been reports of bone marrow hypoplasia after the use of chloramphenicol eye-drops (36,37). 

In a study using general practitioner-based computerized data, 442 543 patients were identified who received 674 148 prescriptions for chloramphenicol eye-drops. Among these patients, there were three with severe hematological toxicity and one with mild transient leukopenia. The causal hnk between topical chloramphenicol and hematological toxicity was not further evaluated in detail (40). 

Of the two types of bone marrow toxicity that chloramphenicol can cause, it may cause the late type only in genetically predisposed patients. The overall risk of aplastic anemia after oral administration of chloramphenicol is 1 30 000 to 1 50 000, which is 13 times greater than the risk of idiopathic aplastic anemia in the population as a whole. Since topical administration achieves systemic effects by absorption through the conjunctival membrane or through drainage down the lacrimal duct, with eventual absorption from the gastrointestinal tract, the risk may be similar to that after oral administration. However, based on two case-control studies and a cohort study, the incidence of blood dyscrasias due to chloramphenicol eye-drops was estimated to be somewhat lower, namely 1 100 000 treated patients (40,66). 

Allergic reactions to chloramphenicol eye-drops include conjunctivitis, keratitis, and palpebral and periocular eczema (47). 

Erythema multiforme caused by local treatment with chloramphenicol eye-drops has been described (47). The possible role of an allergic mechanism in this reaction was suggested, based on a positive mast cell degranulation test (69). 

Rosenthal RL, Blackman A. Bone-marrow hypoplasia following the use of chloramphenicol eye drops. JAMA 1965 191 136-7. 

Lancaster T, Swart AM, Jick H. Risk of serious haematolo-gical toxicity with use of chloramphenicol eye drops in a British general practice database. BMJ 1998 316(7132) 667. 

Wiholm BE, Kelly JP, Kaufman D, IssaragrisU S, Levy M, Anderson T, Shapiro S. Relation of aplastic anaemia to use of chloramphenicol eye drops in two international case-control studies. BMJ 1998 316(7132) 666. 

Chloramphenicol eye drops can be sold as pharmacy-only medicines (P) for limited conditions. The prescription-only medicines (POM) pack is for wider licensed use. 

Antibacterials Chloramphenicol Chloromycetin eye drops and ointment (also available as generic chloramphenicol eye drops and ointment) Superficial eye infections Sale or supply by optometrist in course of professional practice and in an emergency or available from a pharmacy on the presentation of an order signed by a registered ophthalmic optician... 

The BP monograph for Chloramphenicol Eye Drops contains a limit test for 2-amino-l-(4-nitrophenyl)propane-1,3-diol (Figure 8.26). 

Chloramphenicol is active against a wide range of ocular pathogens. It has been the first-choice prescription antibiotic for minor eye infections for many years, and chloramphenicol eye drops were reclassified for pharmacy sale in 2005 for use for adults and children aged 2 years and over. 

Chloramphenicol eye drops should not be used in patients hypersensitive to chloramphenicol, who have experienced myelosuppression during previous exposure to chloramphenicol or with a family history of blood dyscrasias, and it is not recommended for pregnant or breastfeeding women. 

In the pharmacy, chloramphenicol eye drops should be stored in a refrigerator at 2-8°C. Once opened, the drops should be discarded after 5 days. 

Chloramphenicol eye drops should be used to prevent infection. A number of different antibiotics were used in different centres by physicians managing Iranian chemical warfare casualties. These included chloramphenicol, tetracycline, oxytetracycline, bacitracin and polymyxin B. No conclusions regarding the most effective drug could be drawn. There seems little reason to abandon the use of chloramphenical eye drops. 

There is some limited evidence to suggest that the anticoagulant effects of acenocoumarol and dicoumarol can be increased by oral chloramphenicol. An isolated report attributes a marked INR rise in a patient taking warfarin to the use of chloramphenicol eye drops. 

Calnan CD, Sarkany I (1958) Contact dermatitis from neomycin. Br J Dermatol 70 435-445 Campese VM, Marzullo F, Schena FP, Coratelli P (1973) Acute renal failure during intermittent rifampicin therapy. Nephron 10 256-260 Carpenter G (1975) Chloramphenicol eye-drops and marrow aplasia. Lancet 2 326-327... 

Fraunfelder FW, Fraunfelder FT (2013) Restricting topical ocular chloramphenicol eye drop use in the United States. Did we overreact Am J Ophthalmol 156 420-22.66... 

Liver Hepatitis was attributed to conjunctival administration of 0.5% chloramphenicol eye drops in a 37-year-old male engineer with conjunctivitis [31" ]. 

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