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Moledina M, Patel BCK, Malhotra R. Topical Chloramphenicol in Ophthalmology: Old is Gold. Semin Ophthalmol 2024:1-10. [PMID: 39058414 DOI: 10.1080/08820538.2024.2381772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/04/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Topical chloramphenicol is one of the most ubiquitous antibiotics used in ophthalmology and oculoplastic surgery globally. It shows broad-spectrum activity against a variety of different pathogenic organisms, is well tolerated on the ocular surface and displays excellent topical pharmacokinetics. Chloramphenicol has been available for purchase over the counter in the United Kingdom since 2005. Despite this, the largest health economy in the world, The United States has had a de-facto moratorium on its use for the past 30 years. In this review, we aim to evaluate topical chloramphenicol in ophthalmology and oculoplastic surgery and to determine whether its reputation within the US is warranted and justified. METHODS We conducted a comprehensive literature review to evaluate the different facets of chloramphenicol, providing a detailed understanding of the drug, its historical context, the benefits and perceived risks, including safety concerns, and clinical perspectives of its use in clinical practice. RESULTS The mechanism of chloramphenicol, the context around which the drug's use in the US declined, and the drug's evidence base and safety data, including published case reports of serious adverse events, were analysed. The perceived benefits of the drug, particularly in light of antimicrobial resistance and its economic impact, were reviewed. Finally, perspectives on its use in clinical practice in ophthalmology and associated allied specialities were presented. CONCLUSION Chloramphenicol and its topical application have been misunderstood for many decades, particularly in the United States. Its demise across the Atlantic was due to an overzealous response to a dubious association with a weak evidence base. Numerous authors have since validated the safety profile of the and its safety has been borne out. The benefits of chloramphenicol, an effective broad-spectrum agent with a positive cost differential in the era of anti-microbial resistance and fiscal tightening, cannot be understated. Its likely effectiveness as a therapeutic topical agent in ophthalmic surgery makes it a valuable tool in the ophthalmic anti-microbial armoury. We would encourage the reinstatement of this valuable yet misunderstood drug as a first-line agent for simple ophthalmic infections.
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Affiliation(s)
- Malik Moledina
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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Cheung IMY, Horsburgh S, Ziaei M, Gokul A. Ocular Antibiotic Utilisation across Aotearoa/New Zealand. Antibiotics (Basel) 2023; 12:1007. [PMID: 37370326 DOI: 10.3390/antibiotics12061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Ocular antibiotics are integral to the prevention and treatment of bacterial ocular infections. This study aimed to describe their utilisation across New Zealand according to patient and healthcare factors. Every subsidy-eligible community dispensing of ocular chloramphenicol, fusidic acid and ciprofloxacin in New Zealand, between 2010 and 2019, was included in this analysis. Number of dispensings/1000 population/year was quantified, stratified by patient age and urban/non-urban health districts. Dispensing rates by ethnicity were determined and were age adjusted. The proportion of dispensings by socioeconomic deprivation quintile was also determined. Chloramphenicol was the most commonly dispensed antibiotic; however, its utilisation decreased over time. Ciprofloxacin use was higher in children, while chloramphenicol use was higher in older patients. Ciprofloxacin usage was higher among Māori and Pasifika ethnicities, while fusidic acid use was lower. Chloramphenicol usage was higher among Pasifika. Antibiotic utilisation was higher in urban health districts, and in the most deprived quintile; both were most marked with ciprofloxacin. The utilisation of publicly funded ocular antibiotics across New Zealand varied between patient subgroups. These findings will help improve the prevention, management and outcomes of bacterial ocular infections, and support wider initiatives in antibiotic stewardship and medicine access equity.
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Affiliation(s)
- Isabella M Y Cheung
- Department of Ophthalmology, University of Auckland, Auckland 1023, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, University of Auckland, Auckland 1023, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, University of Auckland, Auckland 1023, New Zealand
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3
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Bale BI, Elebesunu EE, Manikavasagar P, Agwuna FO, Ogunkola IO, Sow AU, Lucero-Prisno DE. Antibiotic resistance in ocular bacterial infections: an integrative review of ophthalmic chloramphenicol. Trop Med Health 2023; 51:15. [PMID: 36895063 PMCID: PMC9996861 DOI: 10.1186/s41182-023-00496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/01/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Chloramphenicol is a broad-spectrum antibiotic widely used for treating ophthalmic infections, but concerns about rising bacterial resistance to chloramphenicol have been observed due to its frequent use as an over-the-counter medication. This review assessed the common ophthalmic bacterial pathogens, their chloramphenicol resistance mechanisms, and rates of drug resistance. METHODS PubMed and Google Scholar databases were searched for relevant publications from the years 2000 to 2022, bordering on ophthalmic bacterial infections, chloramphenicol susceptibility profiles, and drug resistance mechanisms against chloramphenicol. A total of 53 journal publications met the inclusion criteria, with data on the antibiotic susceptibility profiles available in 44 of the reviewed studies, which were extracted and analyzed. RESULTS The mean resistance rates to chloramphenicol from antibiotic susceptibility profiles varied between 0% and 74.1%, with the majority of the studies (86.4%) showing chloramphenicol resistance rates below 50%, and more than half (23 out of 44) of the studies showed resistance rates lower than 20%. The majority of the publications (n = 27; 61.4%) were from developed nations, compared to developing nations (n = 14; 31.8%), while a fraction (n = 3; 6.8%) of the studies were regional cohort studies in Europe, with no country-specific drug resistance rates. No pattern of cumulative increase or decrease in ophthalmic bacterial resistance to chloramphenicol was observed. CONCLUSIONS Chloramphenicol is still active against ophthalmic bacterial infections and is suitable as a topical antibiotic for ophthalmic infections. However, concerns remain about the drug becoming unsuitable in the long run due to some proof of high drug resistance rates.
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Affiliation(s)
| | | | | | | | | | - Alhaji Umar Sow
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Pearce JG, Essex RW, Maddess T. Topical chloramphenicol usage in Australia pre- and post-rescheduling as a non-prescription medication. Clin Exp Ophthalmol 2021; 49:762-765. [PMID: 34142410 DOI: 10.1111/ceo.13963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- John G Pearce
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rohan W Essex
- Academic Unit of Ophthalmology, ANUMS, Canberra, Australia.,Department of Ophthalmology, Canberra Hospital, Australia.,Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
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5
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Andaluz-Scher L, Medow NB. Chloramphenicol Eye Drops: An Old Dog in a New House. Ophthalmology 2020; 127:1289-1291. [DOI: 10.1016/j.ophtha.2020.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 10/23/2022] Open
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Yeu E, Hauswirth S. A Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management. Clin Ophthalmol 2020; 14:805-813. [PMID: 32210533 PMCID: PMC7075432 DOI: 10.2147/opth.s236571] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022] Open
Abstract
The diagnosis of acute infectious conjunctivitis can be difficult. Clinical ambiguity exists between the acute viral and bacterial as well as the allergic forms, which can confound diagnosis. Also, discrimination between viral or bacterial origins of infectious conjunctivitis based on historical, nonspecific, clinical signs and symptoms contributes to a high rate of misdiagnosis and overuse of antibiotic treatment. Therefore, in order to effectively treat acute infectious conjunctivitis, physicians must be aware of the clinical signs and symptoms and available diagnostic tests that can provide a more accurate differential diagnosis.
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Affiliation(s)
| | - Scott Hauswirth
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
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7
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Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim. Int J Clin Pharm 2016; 39:165-172. [DOI: 10.1007/s11096-016-0415-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022]
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Silvester A, Neal T, Czanner G, Briggs M, Harding S, Kaye S. Adult bacterial conjunctivitis: resistance patterns over 12 years in patients attending a large primary eye care centre in the UK. BMJ Open Ophthalmol 2016; 1:e000006. [PMID: 29354693 PMCID: PMC5763641 DOI: 10.1136/bmjophth-2016-000006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/19/2016] [Accepted: 10/22/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine whether there was a change in the resistance pattern of bacteria isolated from cases of conjunctivitis following the introduction of over-the-counter availability of chloramphenicol in 2005. Design and setting Retrospective review of laboratory records for adult patients with suspected bacterial conjunctivitis between 2001 and 2012 attending the Royal Liverpool University Hospital. Participants Patients with suspected bacterial conjunctivitis. Organisms were identified by standard laboratory methods. Scanty growth and normal flora were considered as a negative result. For positive results, susceptibility testing was undertaken as per British Society for Antimicrobial Chemotherapy guidelines. Main outcome measures Prevalence of groups of bacteria associated with acute conjunctivitis and their resistance to chloramphenicol, ciprofloxacin, gentamicin, and methicillin. Results A total of 8209 conjunctival swabs were reviewed; 1300 (15.8%) were considered positive, of which 977 (75.2%) and 323 (24.8%) bacteria were identified as Gram positive and Gram negative, respectively. Staphylococcus aureus was the most prevalent organism identified. Resistance of all bacterial isolates to chloramphenicol was 8.4% varying from 3.0% to 16.4% while that for ciprofloxacin and gentamicin was 16.4% and 14.0%, respectively. Methicillin resistance among S. aureus was 8.3%. Conclusion Resistance to chloramphenicol has remained stable since being made available over the counter. Among Gram-positive bacteria, the most prevalent causative agent of bacterial conjunctivitis, chloramphenicol sensitivity remains high.
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Affiliation(s)
| | - Timothy Neal
- Department of Medical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Gabriela Czanner
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Michael Briggs
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Simon Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Stephen Kaye
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
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Nursery sickness policies and their influence on prescribing for conjunctivitis: audit and questionnaire survey. Br J Gen Pract 2016; 66:e674-9. [PMID: 27381485 DOI: 10.3399/bjgp16x686125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/16/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Acute infective conjunctivitis is common among preschool children. Public Health England (PHE) recommends that children with conjunctivitis do not need to be excluded from child care, but childcare providers are required to determine their own sickness policies and prior research suggests that children are often excluded until they are treated or have recovered. How the content of these policies impacts on prescribing decisions has not been quantified. AIM To assess the content of childcare providers' sickness policies and determine the impact they have on clinicians' prescribing. DESIGN AND SETTING An audit of childcare providers' sickness policies and a questionnaire among primary care clinicians. METHOD Sickness policies from childcare providers across the UK were compared with PHE guidance. Clinicians completed a questionnaire on the impact that childcare provider policies have on their decision to prescribe antibiotics to preschool children with conjunctivitis. RESULTS Of 164 policies examined, 86.7% excluded children with conjunctivitis and 49.4% of policies specified a requirement for antibiotics. Two-hundred clinicians completed questionnaires and 42.6% replied that they had been influenced by childcare policies when deciding whether to prescribe antibiotics in this scenario. Furthermore, 15.4% admitted that childcare policies had been the only reason they prescribed antibiotics. CONCLUSION Most of the childcare providers' sickness policies contain requirements that are inconsistent with PHE guidance. The requirements of childcare sickness policies are likely to be resulting in unnecessary primary care consultations and thousands of prescriptions for antibiotics with little demonstrable clinical or public health benefit.
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Both L, Botgros R, Cavaleri M. Analysis of licensed over-the-counter (OTC) antibiotics in the European Union and Norway, 2012. ACTA ACUST UNITED AC 2016; 20:30002. [PMID: 26530125 DOI: 10.2807/1560-7917.es.2015.20.34.30002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/09/2015] [Indexed: 11/20/2022]
Abstract
Antimicrobial resistance is recognised as a growing problem that seriously threatens public health and requires prompt action. Concerns have therefore been raised about the potential harmful effects of making antibiotics available without prescription. Because of the very serious concerns regarding further spread of resistance, the over-the-counter (OTC) availability of antibiotics was analysed here. Topical and systemic OTC antibiotics and their indications were determined across 26 European Union (EU) countries and Norway by means of a European survey. We identified a total of 48 OTC products containing 20 different single antibiotics and three antibiotic combinations as active substances, used mainly as topical preparations in short treatment courses. Given the relevance of these medicines and the increasing risk of antimicrobial resistance, it is important to limit the availability of OTC antibiotics and to monitor their use.
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Affiliation(s)
- Leonard Both
- Public Health England (PHE), London, United Kingdom
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11
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Abstract
Eye problems account for 1.5% of GP consultations in the UK, with a rate of 50 consultations per 1000 population per year. This equates to a yearly cost of 22 billion to the UK’s economy. It has been shown that 50% of sight loss could be avoided through improved eye care services and early detection of problems. To highlight this point, eye health has been chosen by the RCGP as a clinical priority between 2013 and 2016, with a particular focus on the elderly population and sight loss. Data obtained from GPs has revealed that 10–15% of the eye conditions that present to primary care involve the conjunctiva. Conjunctivitis is a particularly beneficial area about which to be knowledgeable, as it is one of the most common non-traumatic eye complaints and in many cases it is straightforward and self-limiting. This article aims to address what constitutes conjunctivitis, the different types, the clinical findings, and management including when to involve specialist services. It will also look at the differential diagnoses of the presenting symptom of the acute red eye.
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Affiliation(s)
- Lucy Rapp
- ST3 GP trainee, Coventry and Warwickshire VTS Scheme
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12
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McDerby N, Watson SL, Robaei D, Naunton M. Inappropriate use of topical chloramphenicol results in vision loss. Clin Exp Ophthalmol 2014; 43:192-3. [PMID: 25363866 DOI: 10.1111/ceo.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 10/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Nikki McDerby
- Faculty of Health, Discipline of Pharmacy, University of Canberra, Canberra, Australian Capital Territory, Australia
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13
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van Weert HCPM, Tellegen E, Ter Riet G. A new diagnostic index for bacterial conjunctivitis in primary care. A re-derivation study. Eur J Gen Pract 2013; 20:202-8. [PMID: 24256320 DOI: 10.3109/13814788.2013.842970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Eighty per cent of primary care patients with infectious conjunctivitis are treated with antibiotics, although in only 30%, there is a bacterial cause. An accurate diagnostic index to distinguish bacterial from viral conjunctivitis may help reduce unnecessary antibiotics. OBJECTIVES To validate and, if necessary, improve an existing diagnostic index for bacterial conjunctivitis. METHODS Non-experimental validation and updating study of an existing diagnostic index in Dutch General Practice. We collected 210 adult patients with incident symptoms suggestive for acute infectious conjunctivitis. GPs completed a standardized questionnaire and a physical examination of the eye(s) and took a conjunctival sample for culture. Cultures were analysed masked for the GPs' findings. On bad performance of the existing index on the new patients, we developed a new index combining the dataset on which the original model had been developed (n = 176) and the new dataset (n = 210). Bootstrapped backward variable selection and shrinkage of regression coefficients was used to protect the new index against bad performance in future patients. RESULTS The bacterial culture was positive in 36.3%. The items age and number of glued eyes at awakening were consistent predictors. This model classified 48% (107/386) of patients at a low (< 25%) chance of having a positive culture and 2% as at high (> 70%) chance. CONCLUSION Correction of a previously derived diagnostic index for bacterial conjunctivitis yielded a simple index, based on history only. The index is potentially useful to rule out bacterial conjunctivitis in patients below 50 years of age with no history of glued eyes at awakening. This study underscores the importance of external validation of diagnostic indices.
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Affiliation(s)
- Henk C P M van Weert
- Academic Medical Center, Department of General Practice, University of Amsterdam , Amsterdam , The Netherlands
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Paudyal V, Hansford D, Cunningham S, Stewart D. Pharmacists' adoption into practice of newly reclassified medicines from diverse therapeutic areas in Scotland: a quantitative study of factors associated with decision-making. Res Social Adm Pharm 2013; 10:88-105. [PMID: 23665077 DOI: 10.1016/j.sapharm.2013.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the UK, over 90 medicines that were previously available only through prescription have been reclassified to allow over-the-counter (OTC) availability via pharmacies. Pharmacists are personally responsible for undertaking or supervising the sales and supplies of these OTC 'pharmacy only' (P) medicines. Reclassification facilitates pharmacy management of a wide range of conditions. OBJECTIVE This research aimed to evaluate Scottish community pharmacists' perspectives of newly reclassified 'P' medicines from diverse therapeutic areas and to identify factors associated with their adoption into practice of these medicines. METHODS A cross-sectional postal survey of all community pharmacies in Scotland (N = 1138) was undertaken. The questionnaire was mailed to the pharmacist responsible for OTC medicines. Four newly reclassified 'P' medicines: omeprazole, naproxen, simvastatin and chloramphenicol eye drops were evaluated. Outcomes of interests included pharmacist support for the reclassified status, perceived adoption into practice of these medicines (i.e., how often they supplied each of these medicines) and factors associated with decision-making. Analyses included descriptive, bivariate correlation, principal component factor and binary regression. RESULTS Five hundred sixty-three pharmacists responded (response rate: 49.5%). Newly reclassified medicines studied had been adopted into practice by the respondent pharmacists to varying degrees. A high majority of the respondents expressed support for the reclassified status (82.4%) and perceived that the level of adoption into practice of OTC chloramphenicol was high (92.1%). In contrast, over 80% of respondents had not yet made a supply of OTC simvastatin to patients, mainly owing to pharmacists' perceptions of lack of evidence of efficacy of the OTC dose and patient demand. Decision-making was influenced by factors such as perceived benefits to patients and pharmacy practice; e.g., respondents who agreed that reclassified naproxen was a good opportunity to develop their professional role were significantly more likely to rate their support for the reclassified status highly than those who were unsure or disagreed (odds ratio = 3.7 (95% confidence interval: 2.1-6.7); P value <0.001). CONCLUSIONS Key factors informing decisions to adopt the reclassified medicines into pharmacists' practice relate to perceptions regarding the benefits of reclassification to patient care and their professional roles. The results have relevance to future reclassification decisions.
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Affiliation(s)
- Vibhu Paudyal
- School of Pharmacy and Life Sciences, Robert Gordon University, Schoolhill, Aberdeen, AB10 1FR, UK
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15
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Jaruseviciene L, Radzeviciene Jurgute R, Bjerrum L, Jurgutis A, Jarusevicius G, Lazarus JV. Enabling factors for antibiotic prescribing for upper respiratory tract infections: perspectives of Lithuanian and Russian general practitioners. Ups J Med Sci 2013; 118:98-104. [PMID: 23521359 PMCID: PMC3633337 DOI: 10.3109/03009734.2013.778925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries. METHOD Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed. RESULTS Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities. CONCLUSIONS Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician-patient level and take into account important factors in the enabling environment as well.
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Affiliation(s)
- Lina Jaruseviciene
- Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Du HCT, John DN, Walker R. An investigation of prescription and over-the-counter supply of ophthalmic chloramphenicol in Wales in the 5 years following reclassification. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 22:20-7. [DOI: 10.1111/ijpp.12033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/22/2013] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
The aims of the study were to (i) quantify the sales of over-the-counter (OTC) ophthalmic chloramphenicol from all community pharmacies in Wales and investigate the impact on primary care prescriptions up to 5 years after reclassification and (ii) investigate the temporal relationship between items supplied OTC and on NHS primary care prescriptions.
Methods
Primary care prescription data (2004–2010) and OTC sales data (2005–2010) for ophthalmic chloramphenicol were obtained. The quantity sold OTC was calculated from pharmacy wholesale records and sales data from a large pharmacy multiple. Spearman’s rank correlation for prescription and OTC supplies of ophthalmic chloramphenicol was calculated for data from January 2008 to December 2010.
Key findings
OTC supply of chloramphenicol eye drops and ointment were both highest in 2007–2008 and represented 68% (57 708/84 304) and 48% (22 875/47 192) of the corresponding prescription volume, respectively. There was a steady year-on-year increase in the combined supply of OTC ophthalmic chloramphenicol and that dispensed on prescription from 144 367 items in 2004–2005 to 210 589 in 2007–2008 before stabilising in 2008–2009 and 2009–2010. A significant positive correlation was observed between prescription items and OTC sales of chloramphenicol eye drops and ointment combined (r = 0.7, P < 0.001).
Conclusion
OTC availability increased the total quantity of ophthalmic chloramphenicol supplied in primary care compared to that seen prior to reclassification. Although growth in the sales of ophthalmic chloramphenicol OTC has stabilised and the supply pattern mirrors primary care prescribers, further work is required to investigate whether use is appropriate and whether the publication of updated practice guidance has changed this.
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Affiliation(s)
- Hank C T Du
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Dai N John
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Roger Walker
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
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Rutter PM. Over-the-counter medicines: their place in self-care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:806-810. [PMID: 22874781 DOI: 10.12968/bjon.2012.21.13.806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Over the last 20 years, there has been a shift in Western countries' healthcare policy to empower patients to exercise self-care by taking greater control in managing their own health, especially in cases where their conditions are deemed minor and self-limiting. In the UK, this has been facilitated by the Department of Health in making more medicines available to the public without the need for a prescription. This article highlights how policy is affecting practice, what attitudes the public and health professionals have toward greater medicine availability, and considers their place in patient management.
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Affiliation(s)
- Paul M Rutter
- Department of Pharmacy, University of Wolverhampton, Wolverhampton, UK
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18
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Pharmacists' attitudes towards an evidence-based approach for over-the-counter medication. Int J Clin Pharm 2011; 34:63-71. [PMID: 22108790 DOI: 10.1007/s11096-011-9586-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 11/07/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND With increasing deregulation of prescription-only medicines and drive for self-care, pharmacists have greater scope to manage more conditions. This brings added responsibility to be competent healthcare professionals who deliver high quality evidence-based patient care. OBJECTIVE This study sought to establish pharmacists' attitudes towards an evidence based approach for over-the-counter medication. SETTING Pharmacists working in community pharmacies across Northern Ireland. METHOD Following ethical approval, a pre-piloted, self-completed questionnaire was distributed to all community pharmacies in Northern Ireland (n = 529) in September 2008. The development of the questionnaire was largely informed by the findings of a previous qualitative study. It consisted of six sections (mainly closed questions) covering factors that influence decisions regarding over-the-counter medication, recently deregulated prescription-only medicines, medications that lack evidence of effectiveness, knowledge of evidence-based practice, evidence-based practice with over-the-counter medication and demographic information. On receipt of questionnaires, responses to the closed questions were imported into SPSS(®) (version 17.0) for analysis which largely took the form of descriptive statistics. Chi-square and the Mann-Whitney U test were used for association between responses and demographic information with an a priori level of less than 0.05 (P < 0.05) set as significant. MAIN OUTCOME MEASURE Pharmacists' attitudes and opinions in relation to decision making about over-the-counter medication and evidence of effectiveness were measured. RESULTS A 39.5% (209/529) response rate was achieved. Most pharmacists [191/208 (91.8%)] 'strongly agreed' or 'agreed' that safety was the over-riding concern when dealing with over-the-counter medication. While 88.3% (181/205) 'strongly agreed' or 'agreed' that they were familiar with the concept of evidence-based practice, only 38.0% (78/205) 'strongly agreed' or 'agreed' they knew how to critically appraise research papers. Furthermore, less than a quarter [49/205 (23.9%)] appeared to be familiar with the work of the Cochrane Collaboration. Most [188/207 (90.8%)] 'strongly agreed' or 'agreed' that regardless of evidence of effectiveness, cough medicines were an important management option. CONCLUSION Safety was the primary concern when making decisions about over-the counter medicines. Pharmacists lacked knowledge of evidence-based practice and considered medicines which lacked evidence of effectiveness to have an important role in self-care. These factors present barriers to the widespread implementation of evidence-based practice.
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Jefferis J, Perera R, Everitt H, van Weert H, Rietveld R, Glasziou P, Rose P. Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis. Br J Gen Pract 2011; 61:e542-8. [PMID: 22152728 PMCID: PMC3162176 DOI: 10.3399/bjgp11x593811] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/21/2011] [Accepted: 03/29/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. AIM To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. DESIGN An individual patient data meta-analysis. METHOD Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. RESULTS Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P=0.03). CONCLUSION Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.
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Golde KT, Gardiner MF. Bacterial conjunctivitis in children: a current review of pathogens and treatment. Int Ophthalmol Clin 2011; 51:85-92. [PMID: 21897142 DOI: 10.1097/iio.0b013e31822d66a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kimberly T Golde
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Phillips CI. Systematic risks from chloramphenicol eye drops. Br J Gen Pract 2010; 60:134. [PMID: 20132719 PMCID: PMC2814277 DOI: 10.3399/bjgp10x483300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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