Evidence summary
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Efficacy
Chloramphenicol inhibits bacterial protein synthesis [1]. It is bacteriostatic, with a relatively broad spectrum against most Gram-positive and Gram-negative bacteria. Uncommon occurrences of acquired resistance are caused by enzyme inactivation.
Topical treatment of bacterial conjunctivitis versus placebo:
Sheikh et al [2] performed a meta-analysis on the efficacy of topical antibiotics for acute bacterial conjunctivitis. Study participants were aged one month or older. Topical antibiotics were of benefit in improving early clinical (day two to five) (RR 1.36, 95% CI 1.15 to 1.61) and microbiological (RR 1.55, 95% CI 1.37 to 1.76) remission rates, as well as late clinical (days six to 10) (RR 1.21, 95% CI 1.10 to 1.33) and microbiological (RR 1.37, 95% CI 1.24 to 1.52) cure rates. By day six to 10, 41% (95%CI 38 to 43) of cases had resolved in those receiving placebo. No serious outcomes were reported. A single trial compared the effect of 0.5% chloramphenicol (1 drop in the affected eye every 2 hours for first 24 hours and 4 times a day until 48 hours after the clinical resolution) versus placebo (boric acid/borax) [3] in children aged 6 months to 12 years with infective conjunctivitis in primary care. There was no significant difference in clinical cure by day 7 (83% for placebo versus 86% with chloramphenicol), with seven (4%) children with chloramphenicol and five (3%) with placebo having further conjunctivitis episodes within 6 weeks. Adverse events were uncommon (2% in each group). [LOE II] Fukuda et al 2002 reported chloramphenicol eye drop treatment of elderly patients with methicillin resistant staphylococcus aureus (MRSA) ocular surface infections had an efficacy rate of 81% [4]. [LOE IV]
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