Chloramphenicol eye ointment

Brodsky E, Biger Y, Zeidan Z, Schneider M. Topical application of chloramphenicol eye ointment followed by fatal bone marrow aplasia. Isr J Med Sci 1989 25(1) 54. 

Liphshitz I, Loewenstein A. Anaphylactic reaction following application of chloramphenicol eye ointment. Br J Ophthalmol 1991 75(1) 64. 

In June 2007, chloramphenicol eye ointment was reclassified from prescription only (POM) to pharmacy sale (P) for the treatment of acute bacterial conjunctivitis. 

Abrams SM, Degnan TJ, Vinciguerra V (1980) Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Intern Med 140 576-577 Adriani J, Zepernick R (1964) Clinical effectiveness of drugs used for topical anesthesia. JAMA 118 711 Albert T, Lewis N, Warpeha R (1982) Late pulmonary complications with use of mafenide acetate. J Burn Care Rehabil 3... 

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. 

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... 

Antibacterial Chloramphenicol framycetin Bacteriostatic or bacteriocidal Eye infections Eye-drop solution, viscous drops, eye ointment, liquid gel... 

The most common category of semisolid eye preparations is a suspension ointment as in chloramphenicol 1 % eye ointment (see Table 10.15). A microfine powdered chloramphenicol substance is used as starting material. The particle size of the powder to be dispersed must comply with Ph. Eur. requirements (see Sect. 10.8). 

As an example, the photodegradation products of chloramphenicol (nitroso-compounds and paranitro-benzaldehyde) are considered carcinogenic. These products will be formed in vitro and in vivo and can reach the bone marrow in rats [37]. Chronic use of chloramphenicol has been coimected with bone marrow depression, not caused by chloramphenicol itself. Apart from the question if this risk is estimated well [38], it can be avoided completely if the patient covers his skin if a dermal preparation has been applied and only use chloramphenicol as eye ointment 1 % at night. See also Sect. 10.5. 

Eye Ointment of Chloramphenicol, B.P.C. Usually contains 1 per cent in a fatty base. 

Multiply resistant coagulase-negative staphylococci are frequently the cause of postoperative endophtalmitis and require the use of a glycopep-tide (e.g. vancomycin). For topical treatment fusidic acid eye gel, tetracycline or chloramphenicol ointment are available, and can be administered 2 t.d. for 7 days. Trachoma should be treated with an oral macrolide (e.g. a single oral dose of 20 mg/kg azithromycin) or doxycyclin for 3 weeks (for moderate to severe cases). Keratitis needs hourly administration of fortified antibiotic eye drops for 2 weeks. Endophtalmitis needs specialist treatment for 6 weeks. 

Topical application of chloramphenicol solution or ointment is effective against most bacterial infections of the external eye. However, because aplastic anemia has also occurred after topical ocular use of chloramphenicol, its use must be limited to infections for which less toxic antibiotics prove ineffective. 

The rise in serum phenytoin levels with intravenous chloramphenicol in adults is well documented and clinically important. A two to fourfold rise can occur within a few days. Concurrent use should be avoided unless the effects can be closely monitored and appropriate phenytoin dosage reductions made as necessary. The use of a single prophylactic dose of phenytoin or fosphenytoin may be an exception to this. It seems very doubtful if enough chloramphenicol is absorbed from eye drops or ointments for an interaction to occur. 

After administration of eye drops, chloramphenicol appeared to disappear very rapidly from the tear film and aqueous humour contrary to the prolonged concentration after administration of the ointment [64, 65]. 

---