OTC shift will boost use of 'ineffective' drops

Academic Primary Care 2006 - OTC eye drops, arthritis, diabetes and statin use.

The shift of chloramphenicol eye drops to OTC is likely to increase their use for acute infective conjunctivitis, even though the treatment is largely ineffective, GPs have warned.

The MHRA decided in June 2005 that chloramphenicol could be bought OTC, making it the first antibiotic to be sold without prescription in the UK.

But GPs attending the Society for Academic Primary Care (SAPC) Annual Scientific Meeting in Keele, Staffordshire, last week were concerned that the availability of the drug OTC could lead patients to ignore the message that conjunctivitis is a self-limiting condition.

Previous studies have shown that 60 per cent of cases resolve spontaneously in two to five days.

Dr Hazel Everett, a GP in Southampton and a Medical Research Council training fellow, who has been studying use of chloramphenicol, said: 'Potentially this will reduce workload. But it will also reduce this opportunity to tell patients that antibiotics are not effective.'

Dr Everett presented research showing that giving patients with acute infective conjunctivitis a scrip for chloramphenicol drops to be used three days later almost halved use of the antibiotic when compared with those given an immediate scrip.

In the study of 250 people, patients given a delayed scrip were half as likely to use antibiotics. A third group given no scrip saw a 70 per cent reduction in antibiotic use.

However, those given a delayed scrip were 30 per cent less likely to reattend in the next two weeks compared with those given no scrip.

Symptom severity and duration were similar, lasting 3.9 days in the delayed scrip group, 3.3 days in the immediate scrip group and 4.9 days in the no scrip group.

This backs up the findings of UK research published last year which showed that chloramphenicol eye drops were no more effective than placebo.

That research was published in the same month as the announcement that chloramphenicol eye drops could be sold OTC.

Oxfordshire GP and lead researcher Dr Peter Rose said he was concerned that pharmacists were unaware of research showing the lack of effectiveness of chloramphenicol eye drops for acute infective conjunctivitis.

He said: 'We did tell the DoH about the trial before it made it OTC, so it obviously had very good reason to make it OTC.'


Delayed prescribing of chloramphenicol:

  • Cut chloramphenicol use by almost half.
  • Provided similar symptom control to immediate prescribing.
  • Cut re-attendance by 30 per cent compared with no initial prescription.

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