Chloramphenicol Eye Ointment Research Articles

The Ocular Chloramphenicol Story

Chloramphenicol eye drops and ointment are the most used ocular antibiotic worldwide. Chloramphenicol was discovered in 1947 and was only the third antibiotic to successfully be produced and only the first antibiotic suitable for large-scale commercial production. By the 1950s, the drug had been developed into drop and ointment forms. The broad spectrum of anti-bacterial activity of Chloramphenicol led to widespread use. Ocular Chloramphenicol remains an important weapon in the ophthalmic armamentarium despite emergence of evidence of possible side effects in the 1970s. This is a short review of the remarkable story of the discovery, development and tribulations of ocular Chloramphenicol. Keywords: History; Chloramphenicol Abbreviations: FDA: Food and Drug Administration

A Case of Bilateral Conjunctivitis in a Seven-Year-Old Shih-Tzu Dog

Background: Conjunctivitis is an inflammation of the conjunctiva that is common in dog, which also known as pink eyes. Conjunctivitis can be caused by infectious agents such as bacteria, chlamydia, and virus, and can also be induced by allergies or due to trauma. Bilateral infection may indicate they are caused by an infectious agent or allergy. Purpose: This study aims to provide veterinarians with insight into the treatment of conjunctivitis cases and the factors that hinder therapy. Case: A seven-year-old female Shih-Tzu dog has had eye problems for six months since April 2023. Physical examination revealed redness in the left and right eyes with mucopurulent exudate. Laboratory examination using an impression smear followed by cytology confirmed inflammation in the eye with many neutrophil cells and coccus-shaped bacteria. The dog was diagnosed with bacterial conjunctivitis with a good prognosis. Case Management: The therapy consisted of the administration of topical antibiotics in the form of Erlamycetin plus® (chloramphenicol and dexamethasone) eye drops for five days, followed by Erlamycetin® (chloramphenicol) eye ointment. Conclusion: After 12 days of therapy, there was no redness in the dog’s eyes and only a small amount of exudate was observed. However, on day 14, the owner reported that exudates were observed in the dog’s eyes. The therapy resulted in improvements but was not optimal because the owner did not consistently follow the recommendations.

PENETRATING EYELID INJURY DUE TO FISHING HOOK : AN UNUSUAL

Introduction : Ocular penetrating injury due to fishing hook is rarely reported. Identifying organ structures involved and determining appropriate approach will affect the outcome. This special case explained penetrating eyelid injury due to fishing hook without ocular involvement.
 Case Illustration : R, boy, 12y.o, came to M.Hoesin ED in January 2023 with complaint of left eye was exposed to fishing hook one hour before admission. Patient was experiencing mild pain with pain scale of three, no blurry vision, excessive tears nor blood. History of immunization was uncomplete.There was no significant visual disturbance. On left superior palpebra, there was a fishing hook penetrated into the medial superior palpebra (partial thickness) without any marginal involvement, no active bleeding, and corneal abrasion in central-paracentral nasal 6-9 o’clock direction. Patient was diagnosed with penetrating eyelid injury due to fishing hook. Intraoperatively back-out technique were performed to extract the fishing hook. Patient was prescribed with 250IU Tetagam injection, chloramphenicol eye ointment, and oral analgetic.
 Discussion : Ocular penetrating fishing hook injury could cause severe complications. In this patient, it only penetrates the eyelid until the dermis layer without marginal involvement. Complications occurred were only corneal erosion with minimal pain. After the operative procedure, topical antibiotic and analgetic were administered. There was no decreased levator palpebra function and corneal erosion was resolved in three days after topical antibiotics were administered.
 Conclusion : Management of ocular penetrating fishing hook injury is challenging. Determining the best technique to extract the fishing hook depends on the depth and type of fishing hook.

PENETRATING EYELID INJURY DUE TO FISHING HOOK : AN UNUSUAL CASE

Introduction : Ocular penetrating injury due to fishing hook is rarely reported. Identifying organ structures involved and determining appropriate approach will affect the outcome. This special case explained penetrating eyelid injury due to fishing hook without ocular involvement.
 Case Illustration : R, boy, 12y.o, came to M.Hoesin ED in January 2023 with complaint of left eye was exposed to fishing hook one hour before admission. Patient was experiencing mild pain with pain scale of three, no blurry vision, excessive tears nor blood. History of immunization was uncomplete.There was no significant visual disturbance. On left superior palpebra, there was a fishing hook penetrated into the medial superior palpebra (partial thickness) without any marginal involvement, no active bleeding, and corneal abrasion in central-paracentral nasal 6-9 o’clock direction. Patient was diagnosed with penetrating eyelid injury due to fishing hook. Intraoperatively back-out technique were performed to extract the fishing hook. Patient was prescribed with 250IU Tetagam injection, chloramphenicol eye ointment, and oral analgetic.
 Discussion : Ocular penetrating fishing hook injury could cause severe complications. In this patient, it only penetrates the eyelid until the dermis layer without marginal involvement. Complications occurred were only corneal erosion with minimal pain. After the operative procedure, topical antibiotic and analgetic were administered. There was no decreased levator palpebra function and corneal erosion was resolved in three days after topical antibiotics were administered.
 Conclusion : Management of ocular penetrating fishing hook injury is challenging. Determining the best technique to extract the fishing hook depends on the depth and type of fishing hook.

First-Onset Dacryocystitis: Characterization, Treatment, and Prognosis.

IntroductionTo assess the risk of recurrent dacryocystitis after first-onset dacryocystitis and to obtain a demographic profile and treatment characteristic for patients with first-onset dacryocystitis.MethodsA retrospective study was performed on patients who had first-onset dacryocystitis during the years 2010–2013. Patients were followed up for 3 years. The analysis focused on the recurrence of dacryocystitis, demographics, medical treatment, and choice of lacrimal surgery.ResultsThe inclusion criteria were met by 52 patients. Of these 15 (29%) had one or more recurrence of dacryocystitis, and 18 patients (34.6%) underwent lacrimal surgery. The mean age was 51.6 years (median 55.5, range 0–93). The female-to-male ratio was slightly under 3:1 (73.1%). The most frequent medical treatment was flucloxacillin capsules combined with chloramphenicol eye drops or ointment.ConclusionsThe majority of patients with first-onset dacryocystitis had no further episodes of dacryocystitis. Some patients experienced recurrent and complicated infections requiring surgery and were thus a significant burden on the healthcare services. Various surgical options were used to clear the nasolacrimal obstruction causing dacryocystitis. Dacryocystorhinostomy was the most common procedure and showed excellent success rate.

No-touch management in tick infestation of periocular skin

Ixodidae ticks are vectors of Lyme borreliosis, Rocky Mountain spotted fever, tick-borne encephalitis, and relapsing fever. We present a case of eyelid tick infestation in a 49-year-old patient for 1 week. A slit-lamp examination suggested it to be a tick tethered on the patient's skin. Complete removal of the tick was done with 2% lignocaine infiltration locally around the swelling. The tick fell off from the periocular skin without any further manipulation. On entomology evaluation, it was categorized to be a hard tick Rhipicephalus sanguineus belonging to the Ixodes family. The patient was put on topical moxifloxacin and chloramphenicol eye ointment. The patient was followed up after 5 days and after 2 weeks and was found to be normal.

Complete eyelid loss due to dog bite: A rare presentation

A 46-year-old male presented with a history of dog bite to the left eye. Examination revealed complete loss of the left upper eyelid with loss of the upper punctum and the surrounding tissue with extensive tissue damage. Anterior segment examination revealed an irregular epithelial defect, and the rest of the findings were unremarkable. After a thorough assessment and cleaning, anti-rabies immunoglobulin injection was given around the wound and anti-rabies vaccination schedule was started. Locally the eye was covered with plastic shield to prevent exposure after instillation of homatropine eye drop as a cycloplegic and chloramphenicol eye ointment as a broad-spectrum antibiotic. Systemically amoxicillin-clavulanic acid and metronidazole was started. Daily dressing was done for about a week. Once signs of healing were seen, the patient was posted for multi-step lid transplantation.

Images in ophthalmia nodosa: an unusual presentation of red eye

Caterpillars, tarantulas and vegetation produce a variety of defence fibres (called setae) uniquely adapted to penetrate the tissues of their target.1 Ophthalmia nodosa (ON) is an ocular inflammatory reaction resulting...

Exposure to topical chloramphenicol during pregnancy and the risk of congenital malformations: a Danish nationwide cohort study

To investigate whether exposure to topical chloramphenicol in the first trimester of pregnancy is associated with congenital malformations. The authors conducted a nationwide cohort study including all women giving live birth between 1997 and 2011 in Denmark. All women redeeming at least one prescription of chloramphenicol eye drops or eye ointment during the first 84 days of pregnancy were identified. Logistic regression was used to estimate the odds ratios of malformations among exposed women compared to non-exposed women. 966 372 births between 1997 and 2011 were included. A total of 6024 women were exposed to topical chloramphenicol in the first trimester. The rate of congenital malformations was 3.50% among offspring of exposed mothers and 3.49% among unexposed. Exposure to topical chloramphenicol in the first trimester was not associated with major congenital malformations (adjusted odds ratio = 1.06, 95% CI 0.91-1.22) or specific major malformations. The number of redeemed prescriptions decreased significantly during pregnancy as compared to before and after pregnancy (p < 0.0001). In this study, we found no association between dispensing of chloramphenicol eye drops or eye ointment in the first trimester of pregnancy and major congenital malformations. This is in accordance with a previous study analysing the risk of systemic chloramphenicol.

Knowledge and practice of primary eye care among primary healthcare workers in northern Nigeria.

To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services.

The Efficacy of 1% Chloramphenicol Eye Ointment Versus 2.5% Povidone-Iodine Ophthalmic Solution in Reducing Bacterial Colony in Newborn Conjunctivae.

This study aimed to evaluate bacterial pattern and reduction of bacterial colonies in neonatal conjunctivae after prophylaxis 1% chloramphenicol eye ointment and 2.5% povidone-iodine ophthalmic solution. A double-blind randomized controlled trial was conducted. Swabs were taken from the inferior fornix conjunctiva of the right eyes of 60 newborns 1 hour after birth. Either the 2.5% povidone-iodine ophthalmic solution or the 1% chloramphenicol eye ointment was randomly applied to the conjunctivae. Conjunctival swabs were taken 2 hours after prophylaxis treatment. Specimens were delivered to the Microbiology Laboratory to determine the number of bacterial colonies and to evaluate bacterial pattern. Sixty eye specimens were included in the study. Bacterial growth was shown in 44 eye specimens, whereas it was not found in the remaining 16 eye specimens. The bacteria found in neonatal conjunctivae was gram-positive coccus (61%), followed by gram-positive bacillus (36%) and gram-negative bacillus (2%). Both agents significantly reduced the bacterial colony-forming unit (P = 0.00); however, the effect was not significantly different as shown by statistics between both groups (P = 0.748), indicating that the 2.5% povidone-iodine ophthalmic solution had a similar effect to the 1% chloramphenicol eye ointment. No adverse effect such as toxic conjunctivitis or corneal haziness was found in both groups. The 2.5% povidone-iodine ophthalmic solution has been proven as effective as the 1% chloramphenicol eye ointment and induces no toxic reaction. Because it is less expensive than the other, it could be recommended as a good alternative for ophthalmia neonatorum prophylaxis. Further studies with a larger sample size should be conducted to confirm its cost-effectiveness.

An investigation of prescription and over-the-counter supply of ophthalmic chloramphenicol in Wales in the 5 years following reclassification

The aims of the study were to (i) quantify the sales of over-the-counter (OTC) ophthalmic chloramphenicol from all community pharmacies in Wales and investigate the impact on primary care prescriptions up to 5 years after reclassification and (ii) investigate the temporal relationship between items supplied OTC and on NHS primary care prescriptions. Primary care prescription data (2004-2010) and OTC sales data (2005-2010) for ophthalmic chloramphenicol were obtained. The quantity sold OTC was calculated from pharmacy wholesale records and sales data from a large pharmacy multiple. Spearman's rank correlation for prescription and OTC supplies of ophthalmic chloramphenicol was calculated for data from January 2008 to December 2010. OTC supply of chloramphenicol eye drops and ointment were both highest in 2007-2008 and represented 68% (57,708/84,304) and 48% (22,875/47,192) of the corresponding prescription volume, respectively. There was a steady year-on-year increase in the combined supply of OTC ophthalmic chloramphenicol and that dispensed on prescription from 144,367 items in 2004-2005 to 210,589 in 2007-2008 before stabilising in 2008-2009 and 2009-2010. A significant positive correlation was observed between prescription items and OTC sales of chloramphenicol eye drops and ointment combined (r=0.7, P<0.001). OTC availability increased the total quantity of ophthalmic chloramphenicol supplied in primary care compared to that seen prior to reclassification. Although growth in the sales of ophthalmic chloramphenicol OTC has stabilised and the supply pattern mirrors primary care prescribers, further work is required to investigate whether use is appropriate and whether the publication of updated practice guidance has changed this.

Community pharmacists' attitudes to their advice-giving role and to the deregulation of medicines

Abstract The attitudes of pharmacists towards their advisory role and to the further deregulation of medicines have been surveyed using a postal questionnaire distributed to a randomly selected 20 per cent (227) of all community pharmacies in Scotland (response rate 90 per cent). Half the pharmacists thought that their role had changed since the publication of the Nuffield report in 1987, 81 per cent that their role was restricted by the range of drugs available for over-the-counter sale, and 93 per cent that they would like to see their role extended by the further deregulation of medicines; fifty eight per cent agreed that there should be a nursing formulary and 74 per cent that a corresponding pharmacists' formulary should be established. Pharmacists were also asked to suggest target preparations for deregulation: ninety per cent suggested at least one preparation, with chloramphenicol eye ointment and drops being the most frequently cited.

Prescribing and sale of ophthalmic chloramphenicol following reclassification to over-the-counter availability

The impact of over-the-counter (OTC) availability of chloramphenicol eye drops and eye ointment was investigated on the prescribing and overall supply of ophthalmic chloramphenicol in primary care. Primary care prescription data for ophthalmic chloramphenicol and ophthalmic antibacterials in England and Wales were analysed from December 2003 (month 1) to September 2008 (month 58). OTC data were analysed from June 2005 when the first OTC product was launched (months 19 to 58). In the 40 months following reclassification more than 2.9 million packs (53.9 per 1000 population) of chloramphenicol were sold in England and 152024 (51.7 per 1000 population) in Wales. In the 12 months to September 2008 sales of the drops and ointment were 67 and 40% of their respective prescription volumes in England. In Wales sales of drops were 52% and ointment 26% of their respective prescription volumes. The number of chloramphenicol packs sold was 2.2 times greater than the calculated reduction in ophthalmic antibacterial prescription items in England and 2.9 times greater than the reduction seen in Wales. Following the reclassification of chloramphenicol there have been significant increases in the supply of the ophthalmic antibacterials in both England and Wales.

Radiolysis characterization of cetostearyl alcohol by gas chromatography-mass spectrometry

Methods for sample preparation, assay test and impurity test were established. Degrees of cetostearyl alcohol (CSA) radiolyses in pure state, ointment base and in chloramphenicol eye ointment (CAPEO) were determined at doses of 25 and 50 kGy. Radiolyses of CSA occur in all cases. The degrees are directly proportional to the irradiation dose in each case. Forty-two impurities and radiolysis products were identified using gas chromatography-mass spectrometry. The radiolysis products were assigned to be n-alkane, n-aldehyde and 2-methyl-1-alcohol. Accordingly, the degradation pathways of cetosteary alcohol were elucidated. Radiolysis behaviors of CSA in pure state, eye ointment base and CAPEO were studied by assay and impurity analyses. The influence of eye ointment matrixes is modest and chloramphenicol molecule exhibits slight scavenger function for cetostearyl. Both qualitative and quantitative data confirm that the radiolysis products of CSA do not cause safety concerns for human use.

Determination of assay and impurities of gamma irradiated chloramphenicol in eye ointment.

A sample preparation method was developed to isolate chloramphenicol and its radiolytic products from an oily ointment base. The isolation method suspended the eye ointment in n-hexane at 45 degrees C, and isolated the target compounds as residue by centrifugation. It was found that the main element to ensure a satisfactory isolation was keeping the sample solution at 45 degrees C during sample preparation. Linearity, precision, accuracy and suitability of the method were confirmed valid for both assay and impurity tests. This isolation method was ideal for assay, unique for extraction of unexpected and complex radiolysis products, and had a number of advantages compared to the pretreatment methods described in The United Stares Pharmacopoeia and British Pharmacopoeia, in terms of accuracy, precision, and easy handling. The effect of gamma-irradiation on chloramphenicol eye ointment was studied by HPLC, after applying the developed sample preparation method. The present assay and impurity test methods with HPLC were confirmed to be suitable for irradiated chloramphenicol in eye ointment. Formation of radiolytic products induced by gamma-irradiation was evidenced by the impurity test. The assay test showed that active ingredient of chloramphenicol eye ointment decreased by 3.3% at an irradiation dose of 25 kGy and by 11.1% at 50 kGy.

Chlamydia trachomatis lower respiratory tract infection in infants.

Chlamydia trachomatis may be an important cause of lower respiratory tract infection (LRTI) in infants born to mothers amongst whom there is a high prevalence of sexually transmitted disease. A study of 100 ambulatory infants with signs of LRTI in South Africa showed that 6% had C. trachomatis infection. The majority of the infected infants had received chloramphenicol eye ointment as prophylaxis. Half had previously visited a health facility for the same illness but the infection has been misdiagnosed. Infants with C. trachomatis infection were According to the Centers for Disease Control (CDC) guidelines, 85% were younger than uninfected infants (mean (SD) age of 3.8 weeks (3.2) vs 8.7 weeks (5.4); p=0.03). Clinical signs significantly associated with chlamydial infection were the presence of eye discharge (p = 0.02) or conjunctivitis (p = 0.01). There was a greater rate of rhinorrhoea (p = 0.06) and wheeze (p = 0.03) amongst patients without chlamydial infection. H. influenzae, M. catarrhalis, S. pneumoniae, S. aureus and N. gonorrhoeae were cultured from five different patients infected with chlamydia. The majority of infants with chlamydial infection had mild disease requiring only outpatient anti- biotic therapy.

Orbital sinus blood sampling in rats as performed by different animal technicians: the influence of technique and expertise.

In this study the influence of orbital sinus blood sampling on clinical signs was studied within the framework of various nutritional experiments. In order to assess the clinical signs in a random design, the rats were punctured in either the left or the right orbit. Thus, the effect of puncture within rats could be determined by comparing the left and right eye. Four animal technicians punctured a total of 303 rats, using different techniques. Orbital sinus blood sampling caused clinically visible alterations. The type, frequency and prognosis of the alterations differed with the person performing the puncture. Two experienced animal technicians were able to perform the technique without causing a statistically significant increase in alterations in punctured orbits. One less experienced animal technician caused severe abnormalities. The use of either a Pasteur pipette or a haematocrit capillary did not necessarily produce different results. Neither did puncturing the lateral vs the medial canthus of the orbit. By not applying chloramphenicol eye ointment in the conjunctival sac after puncture, the number of abnormalities in 'ocular discharge' and 'corneal alterations' in the punctured orbits was significantly decreased. Four punctures in the same orbit with 14-day intervals by a skilled animal technician did not cause a significant increase in abnormalities.

Use of chloramphenicol as topical eye medication: time to cry halt?

Chloramphenicol accounts for over half the general medical services prescriptions for ocular antibiotics in the Republic of Ireland, while in the United Kingdom 55% of patients presenting to general practitioners with “red eyes” are treated with chloramphenicol eye ointment.1 The British National Formulary currently recommends chloramphenicol as the drug of choice for superficial eye infections. It has the advantage that it has a broad spectrum of activity and rarely causes local irritation or hypersensitivity, which may be a problem with other antibiotics. Yet on our wards we no longer prescribe topical ocular chloramphenicol. Why? Since 1950, when Rich et al highlighted the relation between oral chloramphenicol and bone marrow aplasia,2 doctors have been well aware of this side effect. The first death resulting from bone marrow aplasia induced by chloramphenicol eye drops was described by Rosenthal and Blackman in 1955.3 Numerous subsequent …

A study to compare the use of fusidic acid viscous eye drops and chloramphenicol eye ointment in an accident and emergency department.

A total of 300 patients attending an Accident and Emergency department with ophthalmic complaints needing topical antibiotic treatment were treated with fucithalmic or chloramphenicol (chloromycetin). Their compliance and the incidence of side effects were assessed. There was a 70.3% response rate to the questionnaire. Of the patients 51.3% using fucithalmic completed the 5 day course compared with 37.2% of those taking chloramphenicol. However, no patients were found to have suffered as a result of failing to complete the course. The incidence of side effects was similar in both groups.