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Letter to the editor

Editor, Writing as a patient, I wish to point out that in Dr J. Turnidge's editorial on antibiotics ('What to use instead of flucloxacillin' Aust Prescr 1995;18:54-6), he seems to approve of chloramphenicol drops and ointment for the eyes when he refers to its 'popular topical use'.

In another editorial1, the authors warn that chloramphenicol can suppress the bone marrow even when it is applied externally to the eyes. They recommend that it not be used unless there be no alternative and they suggest 'framycetin and fusidic acid are but two of many safer and equally effective preparations'.

John P. O'Brien
Randwick, N.S.W.


Author's comments

Associate Professor J. Turnidge, the author of the editorial, comments:

While mention was made in my paper of chloramphenicol being a popular topical treatment for superficial eye infections, there was no intention on my part to condone its routine use. As Dr O'Brien points out, cases of aplastic anaemia have certainly followed the use of topical eye preparations, and other topical agents can easily be substituted. Unfortunately, attempts to limit the availability of topical eye formulations of chloramphenicol by regulatory authorities in Australia in the past have not been successful. Indeed, the choice of topical antibacterials for ophthalmic use in Australia is quite limited. The choice of an alternative generates similar problems to that of finding substitutes for flucloxacillin. The ideal agent would be nonirritant, non allergenic and preferably not one used for systemic treatment. Many of the currently available agents do not fit the last category e.g. gentamicin, tobramycin, ciprofloxacin, tetracycline and chloramphenicol. Neomycin, framycetin and sulfacetamide are allergenic. Polymyxin B sulfate is not available alone and has poor grampositive cover. Only aminacrine and dibromopropamidine isethionate/propamidine isethionate (Brolene) minimise these problems, yet comparative experience with them is limited. Fusidic acid is not available in Australia for topical eye use. My personal preference is framycetin, but the time is right for development of new topical eye antibacterials using the above principles.


John P. O'Brien

Pathologist, Randwick, N.S.W.

J. Turnidge