From the Guidelines
Chloramphenicol eye drops should be used with caution and under the guidance of a healthcare provider, as they can be effective in treating bacterial eye infections, but their use must be balanced with the potential risks and side effects, as noted in the most recent study 1.
Key Points to Consider
- Chloramphenicol eye drops are a broad-spectrum antibiotic medication used to treat bacterial eye infections such as conjunctivitis, blepharitis, and corneal ulcers.
- The typical dosage is 1-2 drops in the affected eye(s) every 2-6 hours, depending on the severity of the infection, as seen in the study 1.
- Treatment usually continues for 5-7 days, and should be completed even if symptoms improve earlier to prevent recurrence.
- When applying, tilt your head back, pull down the lower eyelid, place the drops in the pocket formed, close your eyes gently for 1-2 minutes, and press on the inner corner of the eye to prevent drainage into the tear duct.
- Chloramphenicol works by inhibiting bacterial protein synthesis, specifically by binding to the 50S ribosomal subunit, which prevents bacteria from producing essential proteins needed for survival.
Important Considerations
- Side effects may include temporary stinging or burning, blurred vision, and rarely allergic reactions.
- This medication should not be used if you have a history of bone marrow depression or are pregnant.
- If symptoms worsen or don't improve within 48 hours, consult your healthcare provider, as recommended in the study 1.
Socioeconomic Considerations
- Bacterial keratitis is a major cause of visual disability, especially in low- to middle-income countries, as noted in the study 1.
- The use of chloramphenicol eye drops may be a cost-effective method of preventing the morbidity and further healthcare costs of bacterial keratitis, as seen in the Bhaktapur Eye Study 1.
From the FDA Drug Label
Chloromycetin Ophthalmic Ointment, 1% (Chloramphenicol Ophthalmic Ointment, USP) is indicated for the treatment of surface ocular infections involving the conjunctiva and/or cornea caused by chloramphenicol-susceptible organisms The particular antiinfective drug in this product is active against the following common bacterial eye pathogens: Staphylococcus aureus Streptococcus, including Streptococcus pneumoniae Escherichia coli Haemophilus influenzae Klebsiella/Enterobacter species Moraxella lucunata (Morax-Axenfeld bacillus) Neisseria species
Chloramphenicol eye drops are indicated for the treatment of surface ocular infections involving the conjunctiva and/or cornea caused by chloramphenicol-susceptible organisms. The drug is active against several common bacterial eye pathogens, including:
- Staphylococcus aureus
- Streptococcus, including Streptococcus pneumoniae
- Escherichia coli
- Haemophilus influenzae
- Klebsiella/Enterobacter species
- Moraxella lucunata (Morax-Axenfeld bacillus)
- Neisseria species 2
From the Research
Chloramphenicol Eye Drops: Efficacy and Usage
- Chloramphenicol eye drops have been widely used in the treatment and prevention of superficial eye infections due to their broad spectrum of activity and low cost 3.
- A study compared the standard dosage of 0.5% chloramphenicol eye drops (one drop hourly/every two hours for three days, thereafter every 4-6 hours) with a simplified dose regimen (four times a day) in patients with acute bacterial conjunctivitis, and found that the simplified regimen may be preferable in clinical practice due to better compliance 4.
- Another study compared the clinical and bacteriological effects of fucidic acid and chloramphenicol eye drops in neonates with acute conjunctivitis, and found that fucidic acid was easier to use and equally effective as chloramphenicol 5.
Comparison with Other Antibiotics
- A study compared the in vitro antibacterial effect and ocular cytotoxicity of moxifloxacin and chloramphenicol, and found that moxifloxacin had a broader spectrum of antibacterial activity and lower corneal cell toxicity compared to chloramphenicol 6.
- Chloramphenicol is experiencing a renaissance due to its broad spectrum of activity, antibiofilm properties, and limited rate of resistance compared to fluoroquinolones 7.
Safety and Resistance
- Concerns have been raised about the risk of aplastic anemia when chloramphenicol is given intravenously, but it seems suitable for use as a topical eye formulation due to its scarce induction of bacterial resistance and antibiofilm activity 7.
- Further studies are needed to address the pharmacodynamics properties of ocular formulation of chloramphenicol, as well as its real impact against biofilm and the ocular microbiota 7.