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Initial treatment of Pseudomonas aeruginosa contact lens-associated keratitis with topical chloramphenicol, and effect on outcome
  1. Rabia Bourkiza1,
  2. Stephen Kaye2,
  3. Catey Bunce3,
  4. Jayendra Shankar4,
  5. Timothy Neal4,
  6. Stephen Tuft1
  1. 1Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
  3. 3Department of Research and Development, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  4. 4Department of Medical Microbiology, Royal Liverpool Hospital, Liverpool, UK
  1. Correspondence to Mr Stephen Tuft, Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London ECV1 2PD, UK; s.tuft{at}


Aim 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.

  • Cornea
  • Contact lens
  • Infection
  • Microbiology

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