Initial treatment of Pseudomonas aeruginosa contact lens-associated keratitis with topical chloramphenicol, and effect on outcome.
OBJECTIVE
To determine whether initial empiric treatment of cases with Pseudomonas aeruginosa contact lens-associated keratitis (CLAK) with chloramphenicol had an adverse effect on outcome.


METHODS
We retrospectively reviewed 139 cases of culture-proven P. aeruginosa CLAK seen between 2007 and 2009. We recorded chloramphenicol use prior to the prescription of a fluoroquinolone, the visual acuity (VA) when the fluoroquinolone was started and at final follow-up, complications and duration of follow-up.


RESULTS
46 patients (33.1%) had used chloramphenicol before they were prescribed a fluoroquinolone. When we compared this group with patients who had initial treatment with a fluoroquinolone, the ulcer size was larger when a fluoroquinolone was started (Mann-Whitney, p=0.018). Although the initial VA was also worse in the chloramphenicol group (p=0.02), and complications more frequent (p=0.016), the final VA in both groups was similar (p=0.29). The chloramphenicol group had a longer median follow-up of 37 days (IQR: 9-310 days) compared with 21 days (IQR: 6-80 days) for the non-chloramphenicol group (p=0.09).


CONCLUSIONS
Chloramphenicol 0.5% eye drops are available in the UK without prescription. Chloramphenicol had been used in one-third of cases of P. aeruginosa CLAK prior to the use of a broad-spectrum antimicrobial, which was associated with more complications and a longer interval to resolution, but with no adverse effect on final VA.
Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Rabia
R
Bourkiza
Stephen
S
Kaye
Catey
C
Bunce
Jayendra
J
Shankar
Timothy
T
Neal
Stephen
S
Tuft
D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002701:Chloramphenicol / Q000627:therapeutic use*; D002702:Chloramphenicol Resistance; D003261:Contact Lenses / Q000382:microbiology*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs; D009883:Ophthalmic Solutions; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D004366:Nonprescription Drugs; D009883:Ophthalmic Solutions; D002701:Chloramphenicol