title: To what extent does a lack of refrigeration of generic chloramphenicol eye-drops used in India decrease their purity and what are the implications for Europe?
abstract: OBJECTIVE
  Thermal degradation of chloramphenicol occurs at a faster rate when stored in unrefrigerated conditions. This study measures the concentration of the principal thermal breakdown product of generic chloramphenicol eye-drops being sold over the counter in chemists in different locations in India.
  
  
  METHODS
  Forty-eight samples of generic chloramphenicol eye-drops were collected form Delhi and Chennai (Madras) in India. Conditions of storage of chloramphenicol eye-drops were recorded at the time of purchase. Concentrations of a hydrolytic degradation product of chloramphenicol were measured using validated high-pressure liquid chromatography. Results were compared with accepted UK standards.
  
  
  RESULTS
  Significantly higher levels of chloramphenicol thermal breakdown product were found in collected samples. All samples purchased were being stored in unrefrigerated conditions in the chemists sampled. Shelf lives exceeded UK equivalents, varying considerably between manufacturers.
  
  
  CONCLUSIONS
  Inadequate refrigeration and prolonged shelf lives of chloramphenicol generics collected from Delhi and Chennai are associated with very high levels of chloramphenicol thermal breakdown product. These levels substantially exceed UK quality-assurance standards undermining product reliability, possibly contributing to the positive selection of resistant organisms and product toxicity effects. The principals of quality-assurance breakdown described are particularly relevant to Europe, following recent deregulation of chloramphenicol eye-drops purchased over the counter.
authors.affiliation: Institute of Ophthalmology, University College London, London, UK. jonathan.aboshiha@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Aboshiha
authors.forename: R
authors.initials: R
authors.lastname: Weir
authors.forename: P
authors.initials: P
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Ewings
authors.forename: A
authors.initials: A
authors.lastname: Lovering
mesh_terms: D000900:Anti-Bacterial Agents / Q000737:chemistry / Q000592:standards*; D002701:Chloramphenicol / Q000737:chemistry / Q000592:standards*; D003234:Conjunctivitis, Bacterial / Q000188:drug therapy; D004355:Drug Stability; D004356:Drug Storage; D016568:Drugs, Generic; D005060:Europe; D006801:Humans; D007194:India; D004366:Nonprescription Drugs / Q000592:standards*; D011786:Quality Control; D013696:Temperature
chemical_list: D000900:Anti-Bacterial Agents; D016568:Drugs, Generic; D004366:Nonprescription Drugs; D002701:Chloramphenicol