| Topical chloramphenicol versus other antibiotic for bacterial conjunctivitis:
Normann et al 2002, in an RCT compared 1% fusidic acid twice a day versus 0.5% chloramphenicol eye drops six times a day in 456 neonates with a clinical diagnosis of acute bacterial conjunctivitis. Clinical cure rate was not significantly different (62.2% with fusidic acid versus 64.7% with chloramphenicol). Clinical compliance was better with fusidic acid (90.7% versus 78.0%).
A review identified five trials that compared chloramphenicol versus fusidic acid eye drops in patients with bacterial conjunctivitis [5]. Three of the five studies reported no difference in effectiveness between the two preparations with both drugs performing equally well [6-8]. Two studies undertaken in less-developed countries showed fusidic acid to be far more effective but the cure rate with chloramphenicol was low, suggesting resistance or different causal agents [9, 10]. [LOE II, GOR C]
Fusidic acid eye drops are not available in Australia.
Safety
Adverse effects were uncommon in trials of topical eye drops [2]. Aplastic anaemia [11, 12], erythema multiforme [13] and drug-induced hepatitis [14] have been reported associated with use of topical chloramphenicol, although all are rare and causality uncertain [1].
Chloramphenicol is not effective for the prevention or treatment of gonococcal or chlamydia ophthalmia neonatorum and may mask clinical signs and delay the diagnosis of gonococcus and chlamydia [15-18].
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