Indian Journal of Pharmacology 2003; 35: 399

LETTER TO THE EDITOR

DRUG UTILIZATION PATTERN OF TOPICAL OCULAR ANTIMICROBIALS IN A TERTIARY CARE HOSPITAL

Periodical auditing of prescribing pattern is vital for promotion of rational use of drugs. According to the World Health Organisation, use of antimicrobials is one of the important core drug use indicators 1. Ocular diseases treated in the Out Patient Department (OPD) often require administration of topical antimicrobial agents. Previous studies have shown that the most frequently prescribed dosage form in Ophthalmology OPD is topical instillation of drugs (eye drops, 76%; ointment, 6.4%; lotion, 0.3%)2. This work was undertaken to study the pattern of use of topical antimicrobial agents in various ophthalmological diseases treated in the Ophthalmology OPD of a tertiary care hospital. This is a prospective study conducted by the Clinical Pharmacology Unit of the Department of Pharmacology, in collaboration with the Department of Ophthalmology of SCB Medical College, Cuttack, from January 2002 to June 2002. Five hundred OPD patients treated with topical ocular antimicrobials were included in this study. Data were collected in a prescribed form and were examined for prevalence of various diseases and pattern of use of antimicrobials. The distribution of diseases treated in the OPD were as follows: corneal ulcer 21%; keratitis 18%; foreign body in the eye,10%; allergic conjunctivitis 10%; blepharitis 8%; post-operative eye infection 7%; postherpetic neuralgia 5%; dacrocystitis 4.5%; infective cyclitis 2%; epiphora 1.5%; chalazion 1.5%; panophthalmitis 1.5% and chemical cyclitis 1%. The percentage use of topical ocular antimicrobial agents were ciprofloxacin 60%; polymixin B + chloramphenicol 8%; chloramphenicol 5%; acyclovir 5%; gentamicin 4.3%; fluconazole 4%; norfloxacin 3.3%; sulfacetamide 3%; tobramycin 3%; neomycin+ polymixin B 3%; and netilmicin 1.4%. Dosage forms of antimicrobials used were eye drops 96.3% and ointment 3.7%. Ciprofloxacin was most commonly used for all the diagnoses except epiphora, in which gentamicin was used and in infective cyclitis, in which a combination of chloramphenicol and polymixin was given. Ciprofloxacin was also the only drug to be used as a single agent in

more than 50% of the therapeutic encounters. As observed in this study, 97% of cases were treated empirically without culture and sensitivity report. Ciprofloxacin is cheap, safe and effective against most of the organisms invading eye3. In the treatment of conjunctivitis and blepharitis, it has been reported that chloramphenicol and ciprofloxacin showed no significant difference in efficacy and safety 4. In case of bacterial keratitis, the success rate was 92% with ciprofloxacin while that was 88% with combination therapy of cefazolin and gentamicin5. In case of corneal ulcer, 97-98% success rate was observed when ciprofloxacin was combined with cephazolin or gentamicin 6. The treatment pattern observed in the OPD of SCB. Medical College,Cuttack, corroborates with the accepted pattern of treatment of ocular diseases. Fluroquinolones such as enoxacin, fleroxacin, levofloxacin, pefloxacin and sparfloxacin are currently being developed as ocular agents. Whether their use as a topical agent will lead to development of drug resistance has to be monitored. M. MOHANTY*, S. MOHAPATRA Department of Pharmacology, SCB Medical College, Cuttack-753 007. *M A - 31, BRIT Colony, Nayapalli, Bhubaneswar-751 012. E-mail: drmmohanty@hotmail.com REFERENCES
1. W H O. DAP 93.1: How to investigate drug use in health facilities. Selected drug use indicators. Action programme on essential drugs. 1995. Biswas NR. Patterns of prescription and drug use in ophthalmology in a tertiary hospital in Delhi. Br J Clin Pharmacol 2001;51:267- 9. Lucy C. Continuing education. J Pharm 2000;264:441 -5. Power WJ, Collum LM, Easty DL, Bloom PA, Laidlaw DA, Libert J, et al . Evaluation of efficacy and safety of ciprofloxacin ophthalmic solution versus chloramphenicol. Eur J Ophthalmol 1993;3:77-82. Liebowitz HM. Clinical evaluation of ciprofloxacin 0.3% ophthalmic solution for treatment of bacterial keratitis. Am J Ophthalmol 1991;112:34-47. Bower. Fluoroquinolones in the treatment of bacterial keratitis. Am J Ophthalmol 1996;121:712-5.

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