Chloramphenicol eye drops 

A warning has been issued about the maximum daily limit for boron exposure in chloramphenicol eye drops containing borax or boric acid (as buffers) for children less than two years of age. 

In July, a MHRA review stated that the benefits outweigh the risks and that the product information would be updated accordingly. A typical dose of one drop used three to four times a day to both eyes would result in a daily exposure below the safety limit of children under than two years of age.

Withdrawal effects on stopping treatment with topical steroids 

Infrequent but severe adverse effects such as redness or burning sensations have been reported on stopping treatment with topical corticosteroids when used continuously for long periods of time to treat conditions such as eczema and psoriasis.¹⁰

These effects are more likely with moderate to high potency products so it is advised that the lowest potency needed is prescribed. These effects may occur days or weeks after stopping treatment. In children, withdrawal may be seen after only two months of continuous treatment.

Advice to patients should include:

• Explaining the amount of product to be applied; underuse can prolong treatment duration
• Informing patients how long they should use a topical corticosteroid for, especially on sensitive areas such as the face and genitals
• Informing patients to return for medical advice if their skin condition worsens while using a topical corticosteroid, and advising them when it would be appropriate to re-treat without a consultation.

Prescribers should consider reducing the potency or frequency of application (or both) for patients currently on long-term topical corticosteroid treatment, and all should look out for the signs and symptoms of topical steroid withdrawal reactions. Remember to report using the Yellow Card scheme.