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Three Part Question

In [neonates with sticky eyes] is [Fucidic acid eye ointment better or worse than chloramphenicol 1% eye ointment] at [curing the condition]

Clinical Scenario

You're having a bad day! You've just seen your third neonate in 2 hours with a sticky eye and the senior nurse informs you that you dispensed the final bottle of chloramphenicol eye drops in the Emergency Department to the last child. In a rapidly deteriorating mood, you ring pharmacy, who suggest fucidic acid (Fucithalmic) eye drops. You wonder if it is comparable to the standard treatment with chloramphenicol.

Search Strategy

Medline via the OVIDSP interface 1948 to May Week 1 2011. Embase via NHS Evidence May 12th 2011. The Cochrane Library May 2011


Medline:[conjunctivitis.mp. or exp Conjunctivitis/ OR ophthalmia neonatorum.mp. or exp Ophthalmia Neonatorum/[ AND [chloramphenicol.mp. or exp Chloramphenicol/ OR exp Fusidic Acid/ or fucidic acid.mp.OR fucithalmic.mp.] LIMIT to English language, human and "newborn infant (birth to 1 month)

Embase:[exp conjunctivitis/ OR Conjunctivitis.ti,ab OR ophthalmia AND neonatorum).ti,ab] AND exp Chloramphenicol/ OR Chloramphenicol.ti,ab OR exp fusidic acid/ OR (Fusidic AND Acid).ti,ab OR fucithalmic.ti,ab] Limit to English language, humans and Age Groups Infant to one year

Cochrane:MeSH descriptor Ophthalmia Neonatorum explode all trees

Search Outcome

The above search returned 53 articles. One was relevant to the three part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Normann et al, 2002, Norway	456 newborns age > 32 weeks with acute conjunctivitis of suspected bacterial origin Fucidic acid vs chloramphenicol for 7 days	Prospective RCT	Cure rate	89% (f.a.) vs. 87.9% (CPL)	Some patients excluded from final analysis (e.g chlamydia infection), however, intention to treat analyses showed no difference between the two groups. Some problems with physician (observer) blinding in some centres.
			Compliance Rate	90.7% vs 78.0% (p<0.001)

Comment(s)

Neonatal conjunctivits is a common (incidence quoted at 8% in some studies) presenting complaint to both emergency departments and primary care physicians. It is commonly caused by staphylococcus aureus. A recent supply problem caused a UK shortage of chloramphenicol for ophthalmic use. Fucidic acid (in it's carbomer preparation, Fucithalmic) has been shown to be equivalent in cure rate and easier to use than chloramphenicol in adults and older children. The carbomer preparation suspends fucidic acid in a gel-like formulation. This confers several benefits; the drug persists in the lacrimal fluid and aqueous humour for at least 12h; the viscosity of the carbomer makes it easier to administer; the carbomer becomes clear on contact with electrolytes in tear fluid causing less blurring. The study addressed the weakness of fucidic acid against other serious pathogens causing ophthalmia neonatorum (e.g. neisseria gonnorrhoea and chlamydia trachomatis) by taking microbiological samples and changing therapy where appropriate. However, n. gonnorrhoea was rare (1% in this study and elsewhere).

Clinical Bottom Line

Fucidic acid drops have an equivalent cure rate to chloramphenicol eye drops in neonates with sticky eyes.

References

1. Normann EK, Bakken O, Peltola J et al. Treatment of acute neonatal bacterial conjunctivitis: a comparison of fucidic acid to chloramphenicol eye drops. Acta Ophthalmol Scand 2002; 80:183-7