Letters 2. 3.
4. 5.
6.
7.
to the
Editor
321
Ludlam HA, Dryden MS, Barton I. Phillips 1. Short course ciprofloxacin therapy for CAPD peritonitis. J Antimicrob Chemother 1990; 26: 162-l 64. Dryden MS, Ludlam HA, Barton I, Phillips I. Intraperitoneal ciprofloxacin for the treatment of peritonitis in patients on continuous ambulatory peritoneal dial>-sis. In Abstracts of the 2nd International Conference of the Zlospital Infection Soriet~~, London. 1990. Abstract P4/6. London: Hospital Infection Society 1990; 71. Dryden MS, Ludlam HA, Phillips I. 4-Quinolone resistant staphylococci. J Atztimicvoh Chemother 1990; 26: 448--449. Ludlam HA, Young AR, Berry AJ, Phillips I. The prevention of infection \vitli Staphylococcus aweUS in continuous ambulatory peritoneal dialysis. J ZZosp Zit(ect 1089; 14: 293-301. Ludlam HA, Noble WC, Marples RR, Bayston R, Phillips I. The epidemiology of peritonitis caused by coagulase-negative staphylococci in continuous ambulator> peritoneal dialysis. J Med Microbial 1989; 30: 167- 174. Ludlam HA, Noble WC, Marples RR, Phillips I. The evaluation of a typing scheme for coagulase-negative staphylococci suitable for epidemiological studies. J Med Microhiol 1989 30: 161-165.
Sir, Topical
antibiotics
in newborn
conjunctivitis
Ophthalmic preparations of chloramphenicol are widely employed in the United Kingdom for the treatment of external ocular infections despite a number of reports associating topical administration with bone marrow depression and aplastic anaemia.‘.” These side effects are presumably the result of local or gastric absorption of chloramphenicol. Ocular infections are not life-threatening and other antibiotics are available which are safer alternatives. The antibacterial spectrum of fusidic acid covers the majority of the common bacterial pathogens responsible for external ocular infections. A comparative study of the efficacy and tolerance of fusidic acid eye drops and chloramphenicol eye ointment in patients between 1 and 90 years of age with acute conjunctivitis showed that fusidic acid was as effective as chloramphenicol and required only twice-daily application compared with the usual 3-hourly applications of chloramphenicol ointment.’ Fusidic acid is known to penetrate into the aqueous humor of adults following ocular administration.6 Since there is little data on the systemic absorption of fusidic acid following external ocular administration, we have studied 12 babies (five female, seven male) with conjunctivitis who received 1% fusidic acid in a gel base (‘Fucithalmic’) 12-hourly. Blood samples were collected after 24-36 h of therapy and assayed by HPLC7 for the presence of fusidic acid. The sensitivity of the assay was 1 mg 1-‘. Fusidic acid was not detected in serum from any of the twelve babies. A serum sample obtained from an infant 24 h after an intravenous infusion of fusidic acid contained 1.7 mg l-‘, confirming that the antibiotic is easily measurable by HPLC. Fusidic acid
Letters
322
to the Editor
may therefore be a safer alternative to chloramphenicol treatment of conjunctivitis in the newborn.
D. E. Holt N. Mahesh Babu J. de Louvois*
Queen Charlotte’s
for the routine
and Chelsea Hospital, Goldhawk Road, London W6 OXG *Correspondence
References 1. Issaragrisil S, Piankijagum A. Aplastic anaemia following topical administration of ophthalmic chloramphenicol: Report of a case and review of the literature. J Med Ass Thailand 1985; 68: 309-312. 2. Abrams SM, Degnan TJ, Vinciguerra V. Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Inntern Med 1980; 140: 576-577. 3. Rosenthal RL, Blackman A. Bone-marrow hypoplasia following use of chloramphenicol eye drops. JAMA 1965; 191: 148-149. 4. Elberg JJ, Hansen WH. Chloramphenicol eye drops and aplastic anaemia. Ugeskr Laeger 1986; 148: 2227-2228. 5. Sinclair NM, Leigh DA. A comparison of fusidic acid viscous eye drops and chloramohenicol eve ointment in acute coniunctivitis. Current Ther Res 1988: 44: 468474: 6. Hansen S. Intraocular penetration of fusidic acid with topical fucithalmic. Eur J Drug Metab Pharm 1985; 10: 329-333. 7. Sorensen H. Liquid chromatographic determination of fusidic acid in serum. J Chromatogr 1988; 430: 400405.
Sir,
Cross contamination
of bronchial
washings
in which four patients The article by Nye et al.’ reflects our experience whose bronchial washings containing acid-fast bacilli were inappropriately treated with standard anti-tuberculous therapy.2 We agree that the problem of contamination of bronchoscopes with environmental mycobacteria is under-recognized and have evidence to support this. The Regional Tuberculosis Reference Laboratory, Dulwich Public Health Laboratory, has had referred to it from hospital laboratories, over a period of 12 months, 21 strains of Mycobacterium chelonae recovered from bronchial washings of 21 patients. We enquired about the possible clinical significance of these strains, the model of bronchoscope(s) and the disinfection protocol for bronchoscopes. In no case was the patient thought to have mycobacterial disease and in all of the disinfection regimens, tap water or deionized tap water was used up to and including the final rinse. All protocols specified removal of suction valves for separate cleaning and all used an automatic washing machine. We are aware of two of these machines becoming contaminated with environmental mycobacteria (personal communications, Mrs D. Aldridge and Dr R. A. Elston).
4. 5.
6.
7.
to the
Editor
321
Ludlam HA, Dryden MS, Barton I. Phillips 1. Short course ciprofloxacin therapy for CAPD peritonitis. J Antimicrob Chemother 1990; 26: 162-l 64. Dryden MS, Ludlam HA, Barton I, Phillips I. Intraperitoneal ciprofloxacin for the treatment of peritonitis in patients on continuous ambulatory peritoneal dial>-sis. In Abstracts of the 2nd International Conference of the Zlospital Infection Soriet~~, London. 1990. Abstract P4/6. London: Hospital Infection Society 1990; 71. Dryden MS, Ludlam HA, Phillips I. 4-Quinolone resistant staphylococci. J Atztimicvoh Chemother 1990; 26: 448--449. Ludlam HA, Young AR, Berry AJ, Phillips I. The prevention of infection \vitli Staphylococcus aweUS in continuous ambulatory peritoneal dialysis. J ZZosp Zit(ect 1089; 14: 293-301. Ludlam HA, Noble WC, Marples RR, Bayston R, Phillips I. The epidemiology of peritonitis caused by coagulase-negative staphylococci in continuous ambulator> peritoneal dialysis. J Med Microbial 1989; 30: 167- 174. Ludlam HA, Noble WC, Marples RR, Phillips I. The evaluation of a typing scheme for coagulase-negative staphylococci suitable for epidemiological studies. J Med Microhiol 1989 30: 161-165.
Sir, Topical
antibiotics
in newborn
conjunctivitis
Ophthalmic preparations of chloramphenicol are widely employed in the United Kingdom for the treatment of external ocular infections despite a number of reports associating topical administration with bone marrow depression and aplastic anaemia.‘.” These side effects are presumably the result of local or gastric absorption of chloramphenicol. Ocular infections are not life-threatening and other antibiotics are available which are safer alternatives. The antibacterial spectrum of fusidic acid covers the majority of the common bacterial pathogens responsible for external ocular infections. A comparative study of the efficacy and tolerance of fusidic acid eye drops and chloramphenicol eye ointment in patients between 1 and 90 years of age with acute conjunctivitis showed that fusidic acid was as effective as chloramphenicol and required only twice-daily application compared with the usual 3-hourly applications of chloramphenicol ointment.’ Fusidic acid is known to penetrate into the aqueous humor of adults following ocular administration.6 Since there is little data on the systemic absorption of fusidic acid following external ocular administration, we have studied 12 babies (five female, seven male) with conjunctivitis who received 1% fusidic acid in a gel base (‘Fucithalmic’) 12-hourly. Blood samples were collected after 24-36 h of therapy and assayed by HPLC7 for the presence of fusidic acid. The sensitivity of the assay was 1 mg 1-‘. Fusidic acid was not detected in serum from any of the twelve babies. A serum sample obtained from an infant 24 h after an intravenous infusion of fusidic acid contained 1.7 mg l-‘, confirming that the antibiotic is easily measurable by HPLC. Fusidic acid
Letters
322
to the Editor
may therefore be a safer alternative to chloramphenicol treatment of conjunctivitis in the newborn.
D. E. Holt N. Mahesh Babu J. de Louvois*
Queen Charlotte’s
for the routine
and Chelsea Hospital, Goldhawk Road, London W6 OXG *Correspondence
References 1. Issaragrisil S, Piankijagum A. Aplastic anaemia following topical administration of ophthalmic chloramphenicol: Report of a case and review of the literature. J Med Ass Thailand 1985; 68: 309-312. 2. Abrams SM, Degnan TJ, Vinciguerra V. Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Inntern Med 1980; 140: 576-577. 3. Rosenthal RL, Blackman A. Bone-marrow hypoplasia following use of chloramphenicol eye drops. JAMA 1965; 191: 148-149. 4. Elberg JJ, Hansen WH. Chloramphenicol eye drops and aplastic anaemia. Ugeskr Laeger 1986; 148: 2227-2228. 5. Sinclair NM, Leigh DA. A comparison of fusidic acid viscous eye drops and chloramohenicol eve ointment in acute coniunctivitis. Current Ther Res 1988: 44: 468474: 6. Hansen S. Intraocular penetration of fusidic acid with topical fucithalmic. Eur J Drug Metab Pharm 1985; 10: 329-333. 7. Sorensen H. Liquid chromatographic determination of fusidic acid in serum. J Chromatogr 1988; 430: 400405.
Sir,
Cross contamination
of bronchial
washings
in which four patients The article by Nye et al.’ reflects our experience whose bronchial washings containing acid-fast bacilli were inappropriately treated with standard anti-tuberculous therapy.2 We agree that the problem of contamination of bronchoscopes with environmental mycobacteria is under-recognized and have evidence to support this. The Regional Tuberculosis Reference Laboratory, Dulwich Public Health Laboratory, has had referred to it from hospital laboratories, over a period of 12 months, 21 strains of Mycobacterium chelonae recovered from bronchial washings of 21 patients. We enquired about the possible clinical significance of these strains, the model of bronchoscope(s) and the disinfection protocol for bronchoscopes. In no case was the patient thought to have mycobacterial disease and in all of the disinfection regimens, tap water or deionized tap water was used up to and including the final rinse. All protocols specified removal of suction valves for separate cleaning and all used an automatic washing machine. We are aware of two of these machines becoming contaminated with environmental mycobacteria (personal communications, Mrs D. Aldridge and Dr R. A. Elston).
