Antibiotics available over the UK counter could be a dangerous trend

In 2005, and quietly, chloramphenicol eye drops started to become available for sale by pharmacists and without a doctor’s prescription. This was heralded at the time as a great advance for patients, who could get treatment for conjunctivitis faster, and for pharmacists, who could be more autonomous.

What is far less clear is whether or not this is actually good for patients. In the same year as the drops were made available, several pieces of research came out questioning whether or not they did much good: they seemed to shorten the time of infection slightly, but overall the usefulness of them as a routine treatment was rightly questioned.

What conclusions can we now draw? A study, by the Department of Primary Health Care at Oxford University reports in this month’s British Journal of General Practice.

In 2004 there were 2.3m prescriptions of chloramphenicol and this fell to 1.9 million in 2007. However, there has been a year-on-year increase in chloramphenicol sales in pharmacies, with a net increase of 47.8 per cent overall – 1.1m extra packs in annual use.

Is this a reflection of more and better treatment for eye infections? I don’t think so: I think it represents over-treatment. I am not aware of any research saying that eye infections weren’t being treated quickly enough pre 2005. I am aware, though, of lots of data everywhere telling us about antibiotic resistance and the problems of treating infection that wasn’t going to respond – because it was viral or because the drugs were inappropriate. And then we have “superbugs”, emerging as we use too much antibiotic…. And then there is the aspect of the pharmacy as a setting for this type of diagnosis.

I suspect the whole antibiotic over the counter thing has its roots in politics, not evidence. The next thing up for pharmacy distribution are antibiotics for urine infections.

Call me old fashioned, but I think that doctors are better able to prescribe antibiotics appropriately for all kinds of reasons. I fear disaster if this trend for more and more antibiotic use continues.