Over the counter chloramphenicol eye drops

After much agonising, in 2005 the Medicines and Healthcare Regulatory Agency (MHRA) in the United Kingdom decided to allow pharmacists to dispense chloramphenicol eye drops and ointment without a doctor’s prescription. Pharmacists used to be able to sell “Golden Eye Ointment,” which contained a sulphonamide, until the sulphonamide component was withdrawn some years ago by the Committee on Safety of Medicines because its clinical activity had not been proved. Chloramphenicol preparations retail at £5.50 (€6.3; 8.5) to £6 each, a little less than the current cost of a prescription.

A recent study shows that the number of units of chloramphenicol eye drops dispensed between 2004 and 2007 increased dramatically, from 2.3 million to 3.4 million a year.1 This rise of 48% coincided with a fall in medical prescriptions of 16%. Might this have led to an increase of resistance in common flora that can cause invasive disease, and if so, does it matter? Eye preparations pass down the nasolacrimal duct, where they will encounter Staphylococcus aureus, and further back into the nasopharynx, where they will meet Streptococcus pneumoniae and Haemophilus influenzae. Chloramphenicol will also be …