Topical Chloramphenicol Research Articles

Initial treatment of Pseudomonas aeruginosa contact lens-associated keratitis with topical chloramphenicol, and effect on outcome

AimTo determine whether initial empiric treatment of cases with Pseudomonas aeruginosa contact lens-associated keratitis (CLAK) with chloramphenicol had an adverse effect on outcome.MethodsWe retrospectively reviewed 139 cases of culture-proven P....

Reaction or infection: topical chloramphenicol treatment

Chloramphenicol is a topical treatment that is used widely, especially in wounds around the eyes. In our practice there have been a number of cases of delayed hypersensitivity to chloramphenicol that has been mismanaged initially as an infective cellulitis. We hope to share some of our experience of this uncommon reaction to highlight the delayed reaction that can occur with topical application of this drug.

Cutaneous granulomatous reaction caused byStenotrophomonas maltophiliafollowing injury

Conflict of interest: none declared. We report the case of an elderly woman who developed a cutaneous granulomatous reaction after an injury to her hand, which was subsequently found to be infected with Stenotrophomonas maltophilia. An 80‐year‐old woman presented with an unusual eruption on her dorsal left hand, at the site of a deep laceration sustained while gardening 2 months previously. The patient’s medical history included sick sinus syndrome, ischaemic heart disease, hypothyroidism and chronic kidney disease, and her medications at the time were warfarin, nicorandil, levothyroxine, furosemide, isosorbide mononitrate and atorvastatin. There was no relevant travel history. At the time of the accident, bleeding from the wound had been prolonged because of the warfarin, but the patient had controlled it with pressure from a damp bath sponge. The wound was closed in primary care using adhesive strips (Steristrips®; 3M, Berkshire, UK) and the patients was prescribed a 7‐day course of oral erythromycin 500 mg four times daily. However, the lesion became progressively painful, with a heavy serous exudate and surrounding nodules. A further week of erythromycin plus topical fusidic acid and chloramphenicol ointments was twice prescribed, pending bacteriology results. Cultures had a profuse growth of S. maltophilia and mixed anaerobes. In vitro susceptibility testing showed that the S. maltophilia strain was resistant to ciprofloxacin and cotrimoxazole, but sensitive to chloramphenicol, which was continued. The mixed anaerobes were sensitive to metronidazole, which was started at 400 mg three times daily for 2 weeks. However, the lesions continued to enlarge although the patient remained systemically well, and she was referred to us.

Methicillin‐resistant Staphylococcus aureus keratitis in a dog

The purpose of this study is to report a case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a dog. A 7-year-old intact male American cocker spaniel that had undergone removal of a nictitating gland was referred for severe ulcerative keratitis. Slit-lamp examination showed swelling of the eyelid, mucopurulent discharge, conjunctival injection and chemosis, diffuse corneal edema and opacity, and a deep ulcer in central cornea. Gram staining of discharge from the eye demonstrated Gram-positive cocci. Despite topical ofloxacin, oxytetracycline and polymyxin B ophthalmic solution and intravenous cefazolin, there was no improvement. Cultures revealed MRSA that was sensitive only to chloramphenicol, vancomycin, lincomycin, and clindamycin. The antibiotic regimen was changed to topical and systemic chloramphenicol. After 9 days of treatment, although inflammation started to be resolved, the dog developed nonregenerative anemia. The antimicrobial regimen was changed again to topical and systemic vancomycin. Inflammation continued to improve over the next week. MRSA should be considered a potential organism in infectious keratitis, especially when general antibiotics are not effective. Although topical and systemic chloramphenicol and/or vancomycin are effective for treating MRSA keratitis, vancomycin should only be used when culture and susceptibility results indicate it is appropriate and no other options are available. To our knowledge, this is the first detailed case report of MRSA keratitis in a dog.

The Comparison of Fluoroquinolones to Nonfluoroquinolone Antibacterial Agents for the Prevention of Endophthalmitis in a Rabbit Model

Topical antibacterial agents, used as an off-label indication, are frequently administered pre- and postoperatively to prevent endophthalmitis. We compared topical treatment with fluoroquinolone (FQ) anti-infectives to non-FQ antibacterial agents to prevent Staphylococcus aureus endophthalmitis. We hypothesize that FQ anti-infectives are more effective than non-FQ antibacterial agents for preventing endophthalmitis. Moxifloxacin 0.5%, ofloxacin 0.3%, gentamicin 0.3%, chloramphenicol 0.5%, polymyxin B/trimethoprim (10,000 units/mL/0.1%), povidone-iodine 5%, and saline were tested for topical treatment to prevent endophthalmitis. Topical treatment was applied every 15 min for 1 h (5 drops) to the left eye of 14 rabbits for each antibacterial agent and saline. After appropriate anesthesia, the anterior chambers were injected with 1×10(5) colony-forming units of a clinical endophthalmitis isolate of a S. aureus that was susceptible to all tested antibacterials. One drop was administered immediately and another 4 drops of topical treatment were applied over 24 h after injection. At 24 h postinjection, the eyes were graded for clinical signs of endophthalmitis (ocular discharge, conjunctivitis/scleral injection, limbal injection, hypopyon*, iritis*, anterior chamber cells*, anterior chamber flare*, corneal infiltration, and fibrin production*) using a severity scale (0-3). The indication of clinical endophthalmitis was a total score of >3.0 for the presentations marked with an asterisk. The data were analyzed using Fisher's Exact Randomization or Mann-Whitney nonparametric testing. Topical ofloxacin (14/14, 100% without endophthalmitis) and moxifloxacin (13/14, 93%) prevented the clinical presentation of endophthalmitis significantly more frequently (P=0.03, Fisher's Exact Test (FE)) than topical gentamicin (7/14, 50%), povidone iodine (4/14, 29%), chloramphenicol (0/14, 0%), polymyxin B/trimethoprim (0/14, 0%), and saline (0/14, 0%). The median total clinical scores for the ofloxacin (0.5) and moxifloxacin (0.8) groups were significantly (P=0.008, Mann-Whitney Test (MW)) lower than gentamicin (5.7), chloramphenicol (17.5), polymyxin B/trimethoprim (21.2), povidone-iodine (15.5), and saline (18.7). The FQs, ofloxacin and moxifloxacin, were more effective in preventing endophthalmitis than the non-FQ antibacterial agents in a rabbit S. aureus endophthalmitis model. The observed results are consistent with the hypothesis that FQs penetrate into the anterior chamber at more effective levels than many of the common non-FQ antibacterial agents.

Chloramphenicol Induced Vitiligo-like Depigmentation

Observation: Vitiligo is a common acquired pigmentary skin disorder related to the selective loss of melanocytes. Aetiology of vitiligo is uncertain but seems to be dependent on the interaction of genetic, immunological and neurological factors. Its pathogenesis is still not understood. Chloramphenicol is one of the substances causing chemical leukoderma. We report an unusual case of topical chloramphenicol induced periocular vitiligo because of its rarity.

Initiating a transfusion protocol for free diep flap breast reconstruction in North Bristol NHS Trust

Initiating a transfusion protocol for free diep flap breast reconstruction in North Bristol NHS Trust

Bluebottle Envenomation–Induced Crystalline Keratopathy

To report a patient who developed a crystalline keratopathy after bluebottle envenomation of the cornea. Case report with histopathological correlation and literature review. A 61-year-old man presented to the Ophthalmology clinic after he was stung in the left eye by a bluebottle while swimming in the sea. He complained of ocular and facial pain, facial swelling, and transient blurred vision. First aid by the beach included a hot shower and methoxyflurane for the pain. Crystalline deposits and pseudodendritiform epithelial defects were noted on slit-lamp examination. Topical chloramphenicol was prescribed, and 2 days after the injury, the cornea was debrided of persisting crystalline material. The cornea healed quickly after debridement with visual acuity improving from 6/9 to 6/6 in the affected eye. Microscopic examination demonstrated the corneal crystals to be irregularly shaped and nonrefractile with squared off edges. Raman spectroscopy partially identified the crystals as calcium based. Although bluebottle stings of the cornea are infrequent, they may be challenging to manage. In addition to inactivation of the nematocysts and pain management, early debridement of the foreign matter may aid in the rapid resolution of the symptoms.

Conjunctival bacterial and fungal flora in healthy horses in the UK

To describe the bacterial and fungal flora of the normal conjunctiva of horses in the UK; to determine the effect of horse age, sex, geographic location, and housing on this flora; and to determine the most appropriate antimicrobial drug(s) for prophylactic treatment of corneal ulcers. A total of 60 adult healthy horses were studied. Swabs of the conjunctiva were obtained from 60 horses housed in two locations within the UK. Specimens were cultured for aerobic bacteria and fungi, and sensitivity against six ophthalmic antimicrobials assessed. The effect of age, sex, location and housing on the frequency of microbial isolation was evaluated. Fifty-four bacterial isolates, representing thirteen genera of bacteria were cultured from 31 (52%) horses. The most frequently isolated bacterial species was Acinetobacter sp (17/32 horses). The majority of isolates (28/54: 52%) were gram-positive. Three genera of fungi (Mucor, Absidia and Aspergillus spp) were isolated from eight (13%) horses. There was no significant effect of geographic location, sex, age or housing on frequency of microbial isolation. Horses from which gram-negative bacteria were isolated were significantly older than horses from which gram-positive bacteria were isolated. High efficacy (greater than 90% of isolates sensitive in vitro) was displayed by chloramphenicol, gentamicin and tetracycline. The microbial species isolated are comparable with studies performed in other countries, although the frequency of Acinetobacter isolation was higher which may reflect a geographic difference. The topical antimicrobials gentamicin and chloramphenicol are appropriate first line antimicrobials for empirical treatment of corneal ulcers in the UK.

Topical chloramphenicol prophylaxis is of dubious benefit in corneal abrasion

Emergency Medicine AustralasiaVolume 23, Issue 2 p. 231-231 Topical chloramphenicol prophylaxis is of dubious benefit in corneal abrasion Joseph Ting, Joseph Ting Mater Public Hospitals – Emergency Department, Raymond Tce South Brisbane, Brisbane, Queensland, AustraliaSearch for more papers by this author Joseph Ting, Joseph Ting Mater Public Hospitals – Emergency Department, Raymond Tce South Brisbane, Brisbane, Queensland, AustraliaSearch for more papers by this author First published: 14 April 2011 https://doi.org/10.1111/j.1742-6723.2011.01406.xCitations: 1 Joseph Ting, MB BS, MSc (Lond), BMedSci, PGDipEpi (LSTHM), FACEM, Senior Staff Specialist. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume23, Issue2April 2011Pages 231-231 RelatedInformation

Biosynthetic corneas ‐ 2 year post human implantation

Abstract Purpose To evaluate biosynthetic corneas as substitutes for donor corneas in humans followed for 2 years. Methods Recombinant human collagen type III was cross‐linked to fabricate corneal substitutes. Following proper study approval, a Phase I study was initiated. 10 patients , scheduled for corneal grafting, were enrolled. Nine had keratoconus and one a deep scar following Pseudomonas keratitis. Lamellar surgery was performed. Six overlying sutures were used to anchor the graft. Topical dexametasone and chloramphenicol was given postoperatively. The sutures were removed after 6 weeks. The patients were followed clinically and evaluated for UCVA, BSCVA and BCLVA. Sensitivity (Cochet‐Bonnet) and Shirmer were tested. Photography, OCT (Visante), topography and IVCM was documented. Results After 3 months all patients had epithelialized and implants were anchored by keratocyte ingrowth. The nerve regeneration after 24 months was lower than normal controls but better than after PKP. The mean BSCVA at 24 months was less than after PKP but BCLCVA came up to par with PKP BSCVA.The corneal thickness was stable between 3 and 24 months at about 400 µm. The Shirmer values were 20 ± 10 mm in operated eyes and 17 ± 8 mm in fellow eyes. At 18 months the sensitivity was 37 mm in operated eyes and 60 mm in fellow eyes. Conclusion Bioengineered corneal substitutes are compatible and promote regeneration of corneal cells. They show stability after 2‐3 months. The results after 2 years will be presented.

Isolated Bilateral Trigeminal Neuropathy in Sarcoidosis Presenting with Neurotrophic Corneal Ulcers

Sarcoidosis is a multisystem granulomatous disease that may affect various organs. Nevertheless, involvement of the trigeminal nerve is exceedingly uncommon. This report presents a rare case of isolated bilateral trigeminal neuropathy presenting with neurotrophic corneal ulcers. The patient was treated with topical chloramphenicol and lubricants, as well as botulinum toxin injection to the upper eyelid to induce ptosis. Our case illustrates the importance of recognizing that bilateral corneal ulceration might be a manifestation of sarcoidosis. Physicians should be aware of this rare association, when treating sarcoidosis patients with eye related symptoms.

Successful management of a delayed case of a corneal foreign body in a cow

A crossbred Jersey cow had been suffering from severe pain for 3 days due to a corneal foreign body. Tranquilization using intravenous triflupromazine (20 mg) followed by Peterson nerve block with 2% lidocaine hydrochloride (13 mL) facilitated examination of the eye and removal of a 12-mm-long (7 mm penetrated plus 5 mm protruding out) dry plant awn from the cornea. Corneal opacity was noted around the puncture site. Direct ophthalmoscopy did not reveal any abnormality in the ocular media. Topical gentamycin (3 mg/mL) and systemic gentamycin (5 mg/kg), along with meloxicam (0.2 mg/kg) for 3 days, followed (on the basis of antibiotic sensitivity) by topical chloramphenicol (5%) for 2 weeks healed the site. Complete resolution of the opacity took an additional 15 days.

Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis

Acute infective conjunctivitis is a common presentation in general practice. In 2005, three placebo-controlled clinical trials showed that use of topical antibiotics had a small effect on time to clinical resolution. In the same year, chloramphenicol eye drops were made available for sale over the counter. To compare the relative impact of clinical trial evidence and a change to over-the-counter availability on community use of topical chloramphenicol. Observational study using mainly routinely collected data for England. National prescribing data for England and local data from general practices in Oxfordshire, England. Data were collated from three sources: GP prescriptions from the Prescription Pricing Authority, wholesale supply to pharmacists from IMS Health, and an audit of delayed prescribing and non-prescribing from electronic consultation records for acute conjunctivitis, in four general practices. The number of general practice prescriptions for topical chloramphenicol fell from 2.3 million in 2004 to 1.9 million in 2007, a reduction of 15.5%. In contrast, over-the-counter sales by pharmacists have increased steadily. The net effect of these changes has been a 47.8% increase in total chloramphenicol use during 2005-2007, with 1.1 million additional packs being used in 2007 compared to 2004. Making an antibiotic available over the counter increases its use substantially. This is in conflict with the important public health message that antibiotic use needs to be reduced to combat resistance. These findings support the views of the Chief Medical Officer that no more antibiotics should currently be made available over the counter.

The use of rituximab in refractory mucous membrane pemphigoid with severe ocular involvement

Mucous membrane pemphigoid (MMP) with ocular involvement is part of a spectrum of autoimmune disease, associated with chronic inflammatory changes and mucous membrane blistering. A 37-year-old gentleman presented to our...

Elimination of the amphibian chytrid fungus Batrachochytrium dendrobatidis by Archey’s frog Leiopelma archeyi

Archey's frog Leiopelma archeyi is a critically endangered New Zealand endemic species. The discovery of the emerging infectious disease, chytridiomycosis, in wild populations of this frog raised concern that this disease may drive the species to extinction. Twelve wild-caught Archey's frogs naturally infected with the amphibian chytrid fungus Batrachochytrium dendrobatidis were monitored in captivity by observing clinical signs, measuring weight gain, and performing repeated PCR tests. Eight frogs were treated with topical chloramphenicol, without PCR results being available, for B. dendrobatidis at the day of entry of the frog into the trial. Eleven of the 12 frogs (92%) cleared their infection within 3 mo of capture, even though they were held at 15 degrees C and in high humidity, conditions that are ideal for the survival and propagation of B. dendrobatidis. B. dendrobatidis in the remaining frog tested positive for the fungus was eliminated after treatment with topical chloramphenicol. None of the 8 frogs exposed to chloramphenicol showed any acute adverse reactions. Archey's frog appears to have a low level of susceptibility to the clinical effects of chytridiomycosis. Individual frogs can eliminate B. dendrobatidis and Archey's frog can apparently be treated with topical chloramphenicol with no acute adverse reactions. However, the small number of specimens treated here requires that more extensive testing be done to confirm the safety of chloramphenicol. The significance of the amphibian chytrid fungus for wild populations of Archey's frog needs to be determined by a longitudinal study in an infected wild population to correlate the presence of B. dendrobatidis in individual frogs. Such a study should occur over a period of at least 3 yr with clinical assessment and monitoring of survival, growth and body condition parameters.

Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial

Objective To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery.Design Prospective randomised placebo controlled double blind multicentre trial.Setting Primary...

Postoperative Lomefloxacin 0.3% Prophylaxis in Strabismus Surgery

Purpose: To evaluate the efficacy of topical lomefloxacin 0.3% versus chloramphenicol 0.2% with polymyxin B 2500 U/ml in the treatment of patients after strabismus surgery. Methods: Seventy-nine consecutive patients who underwent strabismus surgery from April through October 2006 were randomized to receive topical lomefloxacin 0.3% (n = 45, 58 eyes) or chloramphenicol 0.2% with polymyxin B 2500 U/ml (n = 34, 40 eyes) postoperatively, in addition to topical dexamethasone 0.1% and diclophenac 0.1%. The groups were compared for clinical signs of local cellulitis and findings on conjunctival cultures. Results: From postoperative day 1 to day 28, rates of chemosis decreased from 96% to 9.5% in the lomefloxacin group and from 94% to zero in the chloramphenicol group; rates of hyperemia decreased from 100% to zero in both groups. Accordingly, rates of a cumulative clinical sign score (CCSS) decreased from 60% to zero in the lomefloxacin group and 50% to zero in the chloramphenicol group. Rates of positive bacterial cultures dropped from 59.6% preoperatively to 48.3% on day 14 in the lomefloxacin group and from 63% to 47% in the chloramphenicol group. Conclusions: Topical lomefloxacin is a potent alternative to topical chloramphenicol eye drops after strabismus surgery for the control of pain, infection and discharge, chemosis, hyperemia, and conjunctival hemorrhage.

Anterior Uveitis, Poliosis, and Skin Hypopigmentation Associated With Topical Chloramphenicol Allergy Following Ptosis Surgery

The association of uveitis and vitiligo has long been established in specific disease entities: Vogt-Koyanagi-Harada syndrome and sympathetic ophthalmia. We report an unusual case of topical chloramphenicol allergy associated with an anterior uveitis with subsequent poliosis and periocular vitiligo, following anterior approach levator advancement surgery.

The first case of keratitis caused by Nocardia exalbida

Nocardia exalbida was first reported in 2006. We describe a first case of keratitis caused by Nocardia exalbida. Case report A patient presented after two weeks of unsuccessful treatment of a corneal ulcer in her right eye. Nocardia keratitis was diagnosed from her culture results, and the species Nocardia exalbida was determined by phylogenetic studies using gene sequence analysis of 16S RNA. The disk diffusion method showed that this Norcardia sp. was sensitive to many antibiotics. Initially, the patient was treated with topical and systemic antibiotics, and corneal epithelium quickly regenerated. But when corticosteroid eyedrops were added, there was a recurrence of the keratitis. Corticosteroids were stopped, and systemic trimethoprim-sulfamethoxazole and topical tobramycin, colistin, chloramphenicol and sulfisoxazole were given. Within one month the corneal ulcer and infiltration disappeared. This is the first report of keratitis caused by Nocardia exalbida. This species is susceptible to many antibiotics in vitro and clinically. However, supplementation with corticosteroids can lead to recurrence, and care should be taken when corticosteroids are being considered.