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Vote of confidence for Meldrum

I was amused by your correspondent's declaration that making chloramphenicol OTC would save a 3,000-patient practice 34 hours of consultation time a year (Letters, June 18).

This figure assumes a 10-minute consultation, whereas I suspect that most of us see a sticky-eye consultation as a chance to catch up.

More importantly, it also assumes all GP consultations will cease about infective conjunctivitis ­ just like they have ceased about emergency contraception since that went OTC!

The fact is that our local pharmacist has yet to sell OTC levonelle. However, I suspect OTC chloramphenicol will be cheaper than levonelle so the pharmacists will sell more of this and less brolene.

They will doubtless raise the conjuncitivitis profile with advertising, so I suspect we will see patients who are elegible for free prescriptions and patients with treatment failure.

It is quite possible that the net result is an increase in conjunctivitis consultations.

As the majority of primary care infective conjunctivitis is viral, I suspect the end result will be more patients using antibiotics for viruses.

The other more important issues ­ the possibility of delayed diagnosis of other more important causes of red eye and antibiotic resistance ­ have presumably been carefully researched by the regulatory agency and doubtless based on a regional pilot, like most of our recent changes.

Well at least the pharmacists will be happy.

Dr Laurie Davis

Shrewsbury

You published a letter regarding a medical student's audit of perceived GP time being saved with the introduction of over-the-counter chloramphenicol (June 18).

However, as we know, the majority of the time conjunctivitis is viral in origin and does not require any chloramphenicol.

I am opposed to the introduction of chloramphenicol OTC as it will undoubtedly be used in circumstances where it is not required. There is a very small risk of severe side-effects, including aplastic anaemia, and for this reason it is not considered the drug of choice in several other countries.

Consultations in general practice regarding conjunctivitis are an opportunity to educate patients regarding the self-limiting nature of this condition so they are confident to deal with this in future episodes.

Dr David Harniess

Manchester

Laura Weidner's audit (Letters, June 18) showed that a small practice could save 34 hours of consulting time per year now that chloramphenicol was available over the counter. Am I the only GP to be concerned that the diagnosis of an acute red eye could now be made by a community pharmacist with no ophthalmic experience?

I have a real concern that dendritic ulcers, scleritis, anterior uveitis, iritis, foreign bodies and acute glaucoma will now be treated with chloramphenicol. I am also sure that many infants with sticky eyes that need simple bathing will be needlessly treated with an antibiotic. I hope community pharmacists have indemnity cover or would have the good sense to refer most cases back to us.

Dr JP Dias, East Grinstead, West Sussex

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