title: Trends in ophthalmic antimicrobial utilization pattern in Bahrain between 1993 and 2000: a resurgence of chloramphenicol?
abstract: OBJECTIVE
  The occurrence of aplastic anemia following topical administration of ophthalmic chloramphenicol is controversial and debated internationally. We have determined the influence of such debate on the utilization of ophthalmic chloramphenicol in Bahrain, through studying the utilization patterns of ophthalmic antimicrobial preparations by the Ministry of Health, with an emphasis on chloramphenicol, between 1993 and 2000. Cost-implications of these patterns are examined.
  
  
  METHODS
  Information on the annual purchase of ophthalmic antimicrobial drug preparations and their unit price was obtained from the Directorate of Materials Management, Ministry of Health, and analyzed.
  
  
  RESULTS
  In 1993, the 3 most commonly purchased ophthalmic antibacterial preparations were oxytetracycline 1% eye ointment (40.1%); sulfacetamide 10% and 20% eye drops (25.3%); and chloramphenicol 0.5% eye drops and 1% eye ointment (10.8%). In 2000, oxytetracycline remained the most frequently purchased preparation (33%), followed by chloramphenicol (21.2%). Between 1993 and 1999, chloramphenicol purchases fluctuated between 10% to 16.4% with a remarkable increase to 21.2%, in 2000. Chloramphenicol accounted for 8.6% and 15.1% of cost of total ophthalmic preparations purchased in 1993 and 2000, respectively.
  
  
  CONCLUSIONS
  Despite continued concerns of potential risks of ophthalmic chloramphenicol, this preparation is extensively utilized in Bahrain. We are of the opinion that for minor infections, chloramphenicol ophthalmic preparations should be replaced by safer alternatives. Further, we recommend that their use be reserved for ocular infections that are resistant to other antimicrobials, and that ophthalmologists, at the secondary care level, should supervise such treatment.
authors.affiliation: Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain. khlidj@agu.edu.bh
authors.forename: K A
authors.initials: KA
authors.lastname: Jassim Al Khaja
authors.forename: R R
authors.initials: RR
authors.lastname: Sequeira
authors.forename: V S
authors.initials: VS
authors.lastname: Mathur
mesh_terms: D000287:Administration, Topical; D000741:Anemia, Aplastic / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001445:Bahrain; D002701:Chloramphenicol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017723:Drug Utilization Review; D015818:Eye Infections, Bacterial / Q000188:drug therapy; D006801:Humans; D009883:Ophthalmic Solutions
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D002701:Chloramphenicol