Usage
Chloramphenicol + Flurbiprofen is an ophthalmic solution primarily prescribed for bacterial eye infections, particularly conjunctivitis. It combines an antibiotic and a non-steroidal anti-inflammatory drug (NSAID).
Pharmacological Classification:
- Chloramphenicol: Antibiotic
- Flurbiprofen: Non-Steroidal Anti-Inflammatory Drug (NSAID)
Mechanism of Action: Chloramphenicol inhibits bacterial protein synthesis, halting bacterial growth. Flurbiprofen inhibits prostaglandin synthesis, reducing inflammation, pain, and swelling.
Alternate Names
Flubichlor Eye Drops
How It Works
Pharmacodynamics: Chloramphenicol exerts its bacteriostatic effect by binding to the 50S subunit of the bacterial ribosome, inhibiting peptidyl transferase and thus preventing peptide bond formation. Flurbiprofen, like other NSAIDs, inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin production.
Pharmacokinetics: Both drugs are administered topically as eye drops. Chloramphenicol, when administered systemically, is rapidly absorbed from the gastrointestinal tract. It is metabolized primarily in the liver by glucuronidation and excreted in the urine. Flurbiprofen, when administered systemically, is well-absorbed orally, highly protein-bound, metabolized in the liver by CYP2C9, and excreted in urine. When applied topically to the eyes, small amounts of both drugs may be absorbed systemically.
Mode of Action:
- Chloramphenicol: Ribosomal protein synthesis inhibition
- Flurbiprofen: Cyclooxygenase inhibition
Elimination Pathways: Primarily renal excretion for both drugs after systemic administration, following hepatic metabolism. Minimal systemic absorption after topical ophthalmic application.
Dosage
Standard Dosage
Adults: Instill 1-2 drops into the affected eye(s) every 2 hours.
Children: Dosage should be determined by a pediatrician, considering age and weight. Monitor for bone marrow suppression, especially in neonates and premature infants.
Special Cases:
- Elderly Patients: Close monitoring for age-related decline in renal and hepatic function.
- Patients with Renal Impairment: Dosage adjustment may be necessary.
- Patients with Hepatic Dysfunction: Dosage adjustment may be necessary.
- Patients with Comorbid Conditions: Use cautiously in patients with bleeding disorders, peptic ulcers, or those on anticoagulants or NSAIDs.
Clinical Use Cases
- Intubation: Standard dosage.
- Surgical Procedures: Standard dosage, with post-surgical adjustments as needed.
- Mechanical Ventilation: Standard dosage.
- Intensive Care Unit (ICU) Use: Standard dosage, adjusted as per patient condition.
- Emergency Situations: Standard dosage initially, followed by reassessment.
Side Effects
Common Side Effects:
- Eye discomfort
- Eye irritation
- Burning sensation
- Blurred vision
Rare but Serious Side Effects:
- Aplastic anemia (Chloramphenicol - systemic use)
- Gray baby syndrome (Chloramphenicol - systemic use in neonates)
Long-Term Effects: May include bone marrow suppression with prolonged systemic chloramphenicol use.
Adverse Drug Reactions (ADR): Serious adverse reactions include blood dyscrasias (e.g. aplastic anemia) with chloramphenicol, especially with systemic administration.
Contraindications
- Hypersensitivity to either drug
- History of blood dyscrasias (Chloramphenicol)
- Active ocular infections (Flurbiprofen)
- Severe dry eyes or compromised corneas (Flurbiprofen)
- Aspirin/NSAID allergy (Flurbiprofen)
- CABG surgery (Flurbiprofen)
Drug Interactions
- Other topical eye medications
- Anticoagulants
- NSAIDs
Pregnancy and Breastfeeding
Pregnancy: Use with caution. Chloramphenicol can cause “gray baby syndrome” in newborns, particularly if administered near term. Flurbiprofen is contraindicated in the third trimester.
Breastfeeding: Use with caution. Both drugs can be excreted in breast milk. Monitor infants for adverse effects.
Drug Profile Summary
- Mechanism of Action: Chloramphenicol inhibits bacterial protein synthesis; Flurbiprofen inhibits prostaglandin synthesis.
- Side Effects: Eye discomfort, irritation, burning, blurred vision; rarely, aplastic anemia (Chloramphenicol).
- Contraindications: Hypersensitivity, blood dyscrasias, active ocular infections, corneal issues, aspirin/NSAID allergy, CABG (Flurbiprofen).
- Drug Interactions: Other eye medications, anticoagulants, NSAIDs.
- Pregnancy & Breastfeeding: Use with caution. Monitor for side effects.
- Dosage: Adults: 1-2 drops every 2 hours. Pediatric: consult pediatrician.
- Monitoring Parameters: Blood count, liver and kidney function (especially with systemic chloramphenicol).
Popular Combinations
The medication itself is a combination product. Combining it with other ophthalmic medications is usually not recommended without a specific clinical need, due to potential drug interactions.
Precautions
- Wash hands before and after use.
- Avoid dropper tip contamination.
- Monitor for blood dyscrasias with systemic chloramphenicol use.
- Avoid visually demanding tasks until blurred vision clears.
- Assess for pre-existing blood disorders, renal/hepatic impairment.
- Pregnancy/Breastfeeding: Use cautiously.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chloramphenicol + Flurbiprofen?
A: Adults: 1-2 drops in the affected eye(s) every 2 hours. Children: consult a pediatrician for appropriate dosing.
Q2: What are the common side effects?
A: Common side effects are generally local and include eye discomfort, irritation, burning sensation, and blurred vision.
Q3: Can this medication be used during pregnancy or breastfeeding?
A: Use with caution during pregnancy and breastfeeding. Consult a doctor to assess the risks and benefits.
Q4: Are there any serious side effects associated with this medication?
A: Systemic chloramphenicol use can rarely cause serious blood disorders, including aplastic anemia. Topical use carries a much lower risk.
Q5: What should I do if I experience severe or persistent side effects?
A: Discontinue use and consult a doctor immediately.
Q6: Can I use other eye drops with Chloramphenicol + Flurbiprofen?
A: Combining this medication with other eye drops is not recommended without specific instructions from a doctor, due to potential interactions.
Q7: How should I store Chloramphenicol + Flurbiprofen eye drops?
A: Store as directed on the product packaging. Typically, store at room temperature, away from direct sunlight and excessive heat.
Q8: How long should treatment with this medication continue?
A: Continue treatment for the duration prescribed by your doctor, even if symptoms improve earlier. Stopping treatment prematurely may lead to recurrence of the infection.
Q9: What should I do if I miss a dose?
A: If you miss a dose, instill the drops as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not instill double doses.
Q10: Can I drive or operate machinery after using these eye drops?
A: This medication may cause temporary blurred vision. Avoid driving or operating machinery until your vision clears.
