Use of chloramphenicol as topical eye medication: time to cry halt?

Chloramphenicol accounts for over half the general medical services prescriptions for ocular antibiotics in the Republic of Ireland, while in the United Kingdom 55% of patients presenting to general practitioners with “red eyes” are treated with chloramphenicol eye ointment.1 The British National Formulary currently recommends chloramphenicol as the drug of choice for superficial eye infections. It has the advantage that it has a broad spectrum of activity and rarely causes local irritation or hypersensitivity, which may be a problem with other antibiotics. Yet on our wards we no longer prescribe topical ocular chloramphenicol. Why? Since 1950, when Rich et al highlighted the relation between oral chloramphenicol and bone marrow aplasia,2 doctors have been well aware of this side effect. The first death resulting from bone marrow aplasia induced by chloramphenicol eye drops was described by Rosenthal and Blackman in 1955.3 Numerous subsequent …