The Pharmaceutical Journal
Vol 277 No 7411 p126
29 July 2006

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Study authors discourage immediate use of chloramphenicol

Delaying the prescribing of antibiotics for the treatment of conjunctivitis is a more favourable strategy than immediate treatment with chloramphenicol drops, according to the authors of a recent study (BMJ Online First, 17 July 2006, "A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice").

Investigators randomised 307 adults and children, who presented with acute infective conjunctivitis at 30 general practices in southern England, to receive either immediate antibiotic treatment with chloramphenicol drops, delayed antibiotic treatment (prescription to be collected from the surgery at the parents’ or patient’s discretion after three days) or no treatment (control).

The study found that the duration of moderate symptoms was shorter with antibiotics: controls, 4.8 days; immediate antibiotics, 3.3 days (risk ratio 0.7, 95 per cent confidence interval 0.6–0.8); delayed antibiotics, 3.9 days (0.8, CI 0.7–0.9).

Due to the nature of the study, patients in the control group were able to consult their GP, and the GPs were able to prescribe antibiotics as they deemed appropriate. Antibiotic use was highest in the immediate antibiotic group (99 per cent of patients compared with 53 per cent for the delayed antibiotic group). Despite no offer of antibiotics in the control group, significant antibiotic use (30 per cent of patients) still occurred.

The authors found that patients in the delayed treatment group were less likely than those in the control group to revisit the GP within two weeks; however, no significant difference in the number of revisits was found between the immediate antibiotic group and the control group.

The authors conclude that delayed prescribing of antibiotics is probably a better course of action for treating patients with acute infective conjunctivitis in primary care: “It reduces antibiotic use, … provides similar duration and severity of symptoms to immediate prescribing, and reduces reattendance for eye infections.”

Chloramphenicol eye drops were reclassified as a pharmacy medicine last year (PJ, 11 June 2005, p697). A spokeswoman for the Royal Pharmaceutical Society said that the Society’s practice guidance for OTC chloramphenicol reflects current prescribing advice for the treatment of acute bacterial conjunctivitus.

“The Society believes that making this product, with a very good history as a prescribed medicine, available over-the-counter from registered pharmacies enhances choice and increases access. It may also have a beneficial impact on GP workload and prescribing costs by helping to reduce the likelihood of reattendance for eye infections at GP surgeries,” the spokeswoman added.