Topical Chloramphenicol in Ophthalmology: Old is Gold

Area of Science:

• Ophthalmology
• Oculoplastic Surgery
• Pharmacology

Background:

• Topical chloramphenicol is a widely used, well-tolerated antibiotic with broad-spectrum activity.
• Despite its global availability and efficacy, the United States has had a long-standing moratorium on its use.
• This review examines the historical context and evidence surrounding chloramphenicol's use in ophthalmic practice.

Purpose of the Study:

• To evaluate the efficacy and safety of topical chloramphenicol in ophthalmology and oculoplastic surgery.
• To determine if the negative reputation of chloramphenicol in the US is justified.
• To assess its potential role in combating antimicrobial resistance.

Main Methods:

• Comprehensive literature review.
• Analysis of chloramphenicol's mechanism of action, historical decline in US use, and evidence base.
• Review of safety data, adverse event reports, and clinical perspectives.

Main Results:

• Chloramphenicol's decline in the US was based on weak evidence and an overreaction to dubious associations.
• Numerous studies have validated its safety profile.
• It offers significant benefits as a broad-spectrum agent with a positive cost differential, especially relevant in the context of antimicrobial resistance.

Conclusions:

• Topical chloramphenicol has been misunderstood for decades, particularly in the US.
• Its safety and efficacy are well-established, making it a valuable tool in ophthalmic antimicrobial therapy.
• Reinstatement as a first-line agent for simple ophthalmic infections is encouraged.