Year : 1982 | Volume
: 30 | Issue : 2 | Page : 77--79
Systemic septran and chloramphenicol in the treatment of orneal ulcers
Dhanwant Singh, Gobinder S Dhami
Department of Ophthalmology, Government Medical College, Patiala, India
Deptt. of Ophthalmology, Govt. Medical College, Patiala 147 001
|How to cite this article:|
Singh D, Dhami GS. Systemic septran and chloramphenicol in the treatment of orneal ulcers.Indian J Ophthalmol 1982;30:77-79
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Singh D, Dhami GS. Systemic septran and chloramphenicol in the treatment of orneal ulcers. Indian J Ophthalmol [serial online] 1982 [cited 2021 Jan 20 ];30:77-79
Available from: https://www.ijo.in/text.asp?1982/30/2/77/28082
Most patients with corneal ulcers usually receive inadequate or inappropriate antibacterial agents. Of the large array of chemotherapeutic agents, only sulphonamides,, chloramphenicol and co-trimoxazole have been known to cross the blood aqueous barrier and reach the avascular tissues of the eye, more importantly the cornea, aqueous humour and lens. Sulphonamides are not adequately effective against most pathogens and systemic toxicity of chloramphenicol is major disadvantage to the use of this drug. Both the components of co-trimoxazole namely, trimethoprim and sulphonamide, cross blood-aqueous barrier in adequate quantities and are reasonably safe when given systemically. This study was, therefore, designed to determine whether oral cotrimoxazole was a good alternative to systemic chloramphenicol for the treatment of corneal ulcers.
MATERIALS AND METHODS
Patients, 20-50 years old with deep, nonperforating, moderately, severe corneal ulcers with central sloughing, were admitted. After taking a conjunctival swab for bacteriological culture and sensitivity testing, patients were allocated into one of the 2 treatment groups, randomly as under:
Group - 1 : Chloramphenicol 500 mg. 6 hourly for 7 days.
Group-2 : Co-trimoxazole septran 2 tabs. b.i.d. for 7 days.
Both groups received identical topical treatment with atropine and colloidal silver.
On receipt of the bacteriological report after 48 hours, patients in whom the conjunctival swab did not reveal bacterial growth ox culture were excluded. Patients with pseudomonas infection or bacterial pathogens resistant to either chloramphenicol or co-trimoxazole were also excluded.
Patients were following up clinically for 7 days using the criteria of the presence or ab sence of slough, hypopyon and peripheral vascularization. Conjunctival swabs were repedated on days 3 and 7. White blood cell counts were done on day 3, 4 and 7 to detect short term haemopoietic adverse reactions. At the end of the trial there were 40 patients in the chloramphenicol group and 40 patients in the co-trimoxazole group.
Adverse reactions, clinical or haemopoietic, were not seen in any patient in either group.
Because of the lack of penetration of most antibacterials into the avascular cornea and aqueous humour, systemic treatment of bacterial corneal ulcers has been restricted to Chloramphenicol only. Topical colloidal silver as a local antiseptic and atropine to prevent iritis are not adequate, since silver does not reach the deeper tissues of cornea. Chloramphenicol has been considered the only antibacterial agent which, given systemically, penetrates into the cornea and aqueous humor and deals with bacteria present in the deeper corneal tissues. This is of great importance in preventing the extension of the ulcer and possible perforation into the anterior chamber. Although sulphonamides penetrate into the cornea and aqueous humour, the antibacterial action of sulphonamides is not considered adequate enough and certainly not on a par with chloramphenicol. The trimethoprim component of co-trimoxazole has excellent penetration into avascular tissues of the eye, since it has been shown to cross the blood-aqueous barrier. It could, therefore, be expected to produce a therapeutic response approximately equivalent to that of chloramphenicol. In this study it has been shown that both, chloramphenicol and co-trimoxazole, given systemically, produce equivalent therapeutic result, clinically and bacteriologically. We have not been able to compare our results since published literature at our disposal does not reveal any similar study done elsewhere. Even though the result of chloramphenicol and co-trimoxazole treatment in bacterial corneal ulcers are equivalent, it is necessary to bear in mind that chloramphenicol carries with it a potential hazard of fatal aplastic anaemia. Co-trimoxazole, therefore, offers not only an alternative equivalent treatment, but may be also considered to be safer.
The clinical and bacteriological response in patients with proven bacterial corneal ulcers were compared in 80 patients allocated randomly into two groups, 40 patients received 2 gms. of oral chloramphenicol daily and 40 patients received co-trimoxazole in the standard dosage of 2 tablets twice daily. The response to treatment in both groups were equivalent, clinically and bacteriologically, the bacterial pathogens being eradicated within 3 days in both groups. No adverse reactions to either drug was noted in any patient in this study. In view of the potentially fatal haemopoeitic toxicity of chloramphenicol, co-trimoxazole may be considered a suitable alternative and may even be preferred to chloramphenicol.
We are extremely thankful to Messrs. Burroughs Welcomes & Co. (I) Pvt. Ltd. for extending a liberal supply of Tab. Septran and other assistance given. Dr. C. Gupta and Dr. S.N. Goswami, Medical Department, Burroughs Wellcome, Bombay for their kind suggestions.
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