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Medical Forum / General / Vision / November 2005over the counter chloramphenicol
I only found out today that antibiotic drops are now available for sale as over-the-counter medication. No prescription needed. As I get eye infections from time to time in an enucleated socket this is of interest to me. So do the professionals think this is a good move or not? Do the public know when they need antibiotics or is it best left to the doctor? This applies to the UK. What is the position in the US? Ann > So do the professionals think this is a good move or not? Do the > public know when they need antibiotics or is it best left to the > doctor? This applies to the UK. What is the position in the US? Chloramphenicol is shunned in the US because of a (questionable) association with aplastic anemia. I don't think it's a real risk when used topically in the eye. Antibiotics are essentially no help for viral infections, and most "pink eye" episodes are viral, not bacterial. That doesn't stop US doctors from handing out Vigamox and Tobrex for pinkeye. -MT >> So do the professionals think this is a good move or not? Do the >> public know when they need antibiotics or is it best left to the [quoted text clipped - 3 lines] >with aplastic anemia. I don't think it's a real risk when used topically in >the eye. Yes. It's no longer used here as an oral medication because of that reason. >Antibiotics are essentially no help for viral infections, and most "pink >eye" episodes are viral, not bacterial. That is what they are saying here. That the patient doesn't know if the infection is caused by a virus or bacteria but then neither does the doctor. They generally don't do culture and sensitivity tests unless the condition continues. The doctor will say that super-infection by a bacteria is always possible and that is why they give the antibiotics. Ann >That doesn't stop US doctors from handing out Vigamox and Tobrex for >pinkeye. > >-MT > >> So do the professionals think this is a good move or not? Do the > >> public know when they need antibiotics or is it best left to the [quoted text clipped - 23 lines] > > > >-MT In pharmacology I was taught that because of its association with aplastic anemia, chloramphenicol should only be used in life threatening infections. Because of that, I have never used it in clinical practice, and never felt the need to challenge that association because of the availability of other antibiotics. Polysporin has always been available OTC, and there are few topical antibiotics more effective than polysporin (bacitracin and polymyxin B). A secondary bacterial infection often occurs along with a viral infection. Also, in the U.S. the rules of the game are such that children are sent home with any type of eye infection, no matter how benign. This puts the onus on the doctor to "treat" in order to get the child back to school ASAP. I doubt that a viral infection is of much concern to an enucleated eye. DrG >Antibiotics are essentially no help for viral infections, and most "pink >eye" episodes are viral, not bacterial. Speaking as a layperson and mother of small (but growing) children I have to say that my anecdotal evidence supports antibiotic eyedrops every time pinkeye shows up. My son averages three cases of pinkeye per year: beginning of pool season, beginning of school season, and returning from winter holidays. Call it 12 instances over the past 3-4 years, all of which cleared up in two days (though we did treat for the recommended 3) or less with Vigamox. I've had one case of pinkeye in the last 10 years - two days of Vigamox knocked it right out. I've known one person in oh, 20 years, with viral pinkeye. She was unhappy, to put it mildly. +++++++++++++ Reply to the list as I do not publish an email address to USENET. This practice has cut my spam by more than 95%. Of course, I did have to abandon a perfectly good email account... There are different types of viral pinkeye. The most common is mild and self-limiting. The more severe form is called EKC, which is accompanied by lots of eyelid swelling and a keratitis which can cause pain and reduced vision. The symptoms may take months to clear. Topcial antibiotics do not alter the course of any viral infection, except to alter the quality and quantity of discharge and other effects if a secondary infection occurs. Vigamox and Zymar are the latest fluoroquinolone antibiotics. They are heavily promoted by the pharmaceutical reps, who hand them out like candy. These newer antibiotics are the last line of defense against serious corneal infections by organisms that have become resistant to other antibiotics. When challenged on this issue, the standard retort by the pharmaceutical rep is that there is no possibility of resistance developing against these drugs, so use them with abandon. I distinctly remember being told the very same thing when the first generation fluoroquinolones were launched, and then the first case of resistance was reported within a year. Is handing out Vigamox for every case of pinkeye good medicine, or is it questionable medicine but good economics? DrG "Wooly" <nobody@nun.ya> wrote in message > holidays. Call it 12 instances over the past 3-4 years, all of which > cleared up in two days (though we did treat for the recommended 3) or > less with Vigamox. Do you wonder how soon they'd clear up without treatment? > I've known one person in oh, 20 years, with viral pinkeye. She was > unhappy, to put it mildly. Several different viruses cause pinkeye, mostly rhinovirus and adenovirus. Some adenovirus infections can last for months. -MT
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