Chloramphenicol eye drops not needed for children
Most children who present with infective conjunctivitis in primary care do not need treatment with an antibiotic, according to research published online this week.
Peter Rose, department of primary health care, University of Oxford,
and colleagues conducted a randomised controlled trial involving 326
children aged between six months and 12 years with a clinical diagnosis
of conjunctivitis. Half of them received chloramphenicol 0.5 per cent
eye drops and half received placebo. The drops were instilled in the
affected eye every two hours for the first 24 hours then four times a
day until 48 hours after symptoms resolved. Children were followed up
for six weeks to identify relapse.
The researchers found that there was no significant difference in the
clinical cure rate, with 86 per cent of children in the chloramphenicol
group and 83 per cent of children in the placebo group having no symptoms
at day 7. The mean difference in time to clinical cure was 0.3 days (standard
deviation 0.75 to 0.09 days). Bacterial eradication was higher in the
chloramphenicol group (40 per cent) than the placebo group (23 per cent).
Relapse rate was less than 5 per cent and cases were evenly distributed
between the groups.
“We have shown that symptoms resolve without antibiotics in most
children with acute infective conjunctivitis,” say the researchers.
They add: “About half a day was gained in time to resolution between
children treated with antibiotic and those with placebo, but this gain
has to be weighed against the personal and health care costs of a condition
that improves without treatment.”
Commenting on the decision to make chloramphenicol available over the
counter, Dr Rose told The Journal: “This decision seems to continue
to medicalise a mild and self-limiting condition. I hope that pharmacists
will tell parents of children with conjunctivitis that the treatment
does not convey any significant benefits to the rate of cure, in which
case most parents will not purchase it.”
David Pruce, director of practice and quality improvement at the Royal
Pharmaceutical Society, said: “We would like to reassure pharmacists
that the Society’s guidance regarding OTC chloramphenicol in the
management of acute bacterial conjunctivitis reflects current best practice.” He
added that the Society believes that an in-depth analysis of the paper
and more comprehensive research and data is required before any consideration
is given to whether or not there needs to be a change in pharmacy or
medical practice.
The research is accessible on The Lancet's website |
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