The Pharmaceutical Society of Australia has released a guideline on the provision of chloramphenicol for ophthalmic use for bacterial conjunctivitis. The guideline covers four steps to be taken by pharmacists in the dispensing of chloramphenicol.

Meet professional obligations

• Pharmacists are obliged to the Professional Practice Standards (PPS) and the Code of Ethics for pharmacists
• Pharmacists must meet their obligations in relation to respecting the patient’s privacy and confidentiality
• Pharmacists are encouraged to document the service provided according to the PPS

Assess patient’s needs

Consider if patients have ocular symptoms, co-existing symptoms, and prior similar episodes. Also, take their lifestyle, medical and family history, and current medicines into account.

Patients with ocular symptoms requiring further investigation should be referred to an optometrist or a GP. Referral to a GP may be the most appropriate pathway in the presence of systemic symptoms. Referral to an ophthalmologist or hospital emergency department is recommended in circumstances requiring immediate referral.

Confirm recommendations

The majority of acute bacterial conjunctivitis cases spontaneously resolve within five days, although chloramphenicol ophthalmic preparations can be given to speed resolution and preventing transmission. It also can be used in children of any age, although referral to an optometrist or GP is recommended for children under 2 years.

The use of systemic chloramphenicol by pregnant women may cause serious toxicity in the infant or fetus; however, topical chloramphenicol in the recommended dose is safe to use during pregnancy, and single courses of eye drops are considered safe during breastfeeding.

Ophthalmic chloramphenicol is contraindicated in patients with a history of hypersensitivity and/or toxic reaction to chloramphenicol or to any other ingredient in the drops or ointment base, and in patients with a family history of blood dyscrasias.

Provide Counselling

Chloramphenicol 0.5% eye drops for bacterial conjunctivitis, one or two drops every two hours initially, decreasing to six-hourly as the infection improves, for up to five days. Chloramphenicol 1% eye ointment may be used at bedtime or applied every three hours. For drops, the bottle should be squeezed to release one drop into the lower eyelid. For ointment, 1.5 cm should be applied into the lower eyelid.

Patients should be advised to consult an optometrist or GP if symptoms deteriorate or do not improve within 48 hours as this may indicate infection by nonsusceptible organisms. Adverse effects are usually minor and may include a transient stinging sensation in the eye, eye redness and swelling, and transient blurring of vision.

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