Chloramphenicol Eye Drops: Concerns and Blood Test Recommendations

Chloramphenicol eye drops

Hello doctor, I recently visited an ophthalmology clinic due to conjunctivitis, and the doctor prescribed me chloramphenicol eye drops to use four times a day, one drop each time.
After using it for 4-5 days, I researched chloramphenicol online and found that one of its side effects can be aplastic anemia.
I immediately stopped using the medication.
I would like to know if I need to go to the hospital for a complete blood count test.
PS.
My platelet count has always been low, around 100,000, and my white blood cell count fluctuates between approximately 3,500 and 5,500, while my hemoglobin levels are relatively normal, ranging from 14 to 15.5.

Lai En, 30~39 year old female. Ask Date: 2019/05/21

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Ryan,
1.
Chloramphenicol eye drops are widely used in clinical practice due to their excellent lipid solubility and superior corneal penetration.
Based on actual conditions, they can be administered approximately every 1 to 4 hours; the treatment course must be completed to achieve optimal efficacy.
While systemic administration of chloramphenicol, either intravenously or orally, does carry a risk of aplastic anemia, there have been no reports indicating that ocular administration leads to this condition.
There are concerns regarding the potential effects of long-term use; however, there is currently no definitive evidence to support this.
Therefore, it remains clinically acceptable for use.
2.
This medication binds to the 50S ribosomal subunit of bacteria, inhibiting the peptidyl transferase reaction in the protein synthesis process.
The similarity between mitochondrial ribosomes in mammals and bacterial ribosomes means that high concentrations of chloramphenicol can inhibit protein synthesis within organelles, leading to bone marrow toxicity.
Chloramphenicol is a broad-spectrum antibiotic that not only targets bacteria but also other microorganisms, such as rickettsiae.
3.
If you have further questions, please discuss them with your ophthalmologist before making any decisions.
On the other hand, regarding the issue of low platelet count, I recommend that you consult a hematologist to clarify the matter.
Sincerely,
Doctor Q&A Teams

Reply Date: 2019/05/21

More Info

Chloramphenicol eye drops are a commonly prescribed treatment for bacterial conjunctivitis due to their effectiveness against a wide range of bacteria. However, as you have discovered, there are significant concerns regarding their potential side effects, particularly the risk of aplastic anemia, which is a serious condition that can lead to a decrease in red blood cells, white blood cells, and platelets. This risk is particularly concerning for individuals who may already have pre-existing blood disorders or low blood cell counts.

Given your history of low platelet counts (around 100,000) and fluctuating white blood cell counts (between 3,500 and 5,500), it is prudent to be cautious with any medication that has the potential to exacerbate these issues. Chloramphenicol has been associated with idiosyncratic reactions, meaning that while it may be safe for many patients, some individuals may experience severe side effects, including bone marrow suppression.

In your case, since you have already stopped using the chloramphenicol eye drops after 4-5 days of treatment, it is advisable to monitor your health closely. While the risk of developing aplastic anemia from short-term use is relatively low, it is still a possibility, especially given your underlying blood conditions. Therefore, it would be wise to consult with your healthcare provider about your concerns. They may recommend a complete blood count (CBC) to assess your current blood cell levels, including red blood cells, white blood cells, and platelets. This test can help determine if there has been any significant change in your blood counts since you stopped the medication.

Additionally, if you experience any symptoms such as unusual bruising or bleeding, persistent fatigue, or signs of infection (like fever or chills), you should seek medical attention promptly. These symptoms could indicate a drop in your blood cell counts and may require immediate evaluation.

In summary, while chloramphenicol can be an effective treatment for bacterial conjunctivitis, its potential side effects warrant caution, especially in patients with pre-existing blood disorders. It is advisable to have a blood test to monitor your blood counts after stopping the medication, and to maintain open communication with your healthcare provider regarding any concerns or symptoms you may experience. Your health and safety should always be the priority, and your provider can help guide you through the best course of action based on your individual health status.

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