The Australian Medical Association (AMA) and the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) have issued a joint media statement opposing the rescheduling of an antibiotic and warning of the dangers of doing so.
In the joint statement both organisations say they strongly disagree with the decision to reschedule Chloramphenicol eye drops from the Schedule 4 listing to a Schedule 3 medication.
Schedule 4 medications are prescribed by registered medical practitioners or endorsed optometrists. Schedule 3 medications are available to the public from a pharmacist without a prescription.
RANZCO President, Dr. Richard Stawell, said that Chloramphenicol was one of the most frequently used antibiotics prescribed by ophthalmologists.
“Its use should be reserved for bacterial eye infections or to prevent serious infection, postoperatively, and it is very important that it is not used indiscriminately,” Dr. Stawell said.
“The AMA and RANZCO have major concerns that pharmacists will be guiding patients in the use of Chloramphenicol. Pharmacists have not been trained to be competent in diagnosing eye disease and do not have the appropriate equipment to properly examine an eye.
“There is great variety of different causes of a red discharging eye. It is very easy for an incorrect diagnosis to be made, and the wrong drug prescribed. Some eye diseases can cause irreversible loss of sight,” Dr. Stawell said.
AMA President, Dr. Andrew Pesce, said that first-line eye care is the domain of general practitioners and optometrists, who are readily accessible to patients.
“General practitioners have been specifically trained in clinical diagnosis and appropriate drug use,” Dr. Pesce said.
“It takes many years to train a medical practitioner to assess, diagnose and treat eye conditions properly. Pharmacists have not been similarly trained.
“Both the AMA and RANZCO strongly advised against the rescheduling of Chloramphenicol, and we strongly disagree with this decision, which is not in the best interests of people in need of specialised care for their eye conditions,” Dr. Pesce said.
The rescheduling of Chloramphenicol to OTC would also affect concession card holders and potentially contribute to increased Chloramphenicol resistance.
At its last meeting, the National Drugs and Poisons Schedule Committee (NDPSC) rejected concerns that pharmacists did not have the ability to distinguish between mild cases of bacterial conjunctivitis and other serious causes of red eye such as the herpes virus.
According to the publication Pharmacy eNews: “Criticism of the rescheduling of conjunctivitis treatment, Chloramphenicol, as a Schedule 3 (S3) medication is being seen as an attack on medical continuance.
“Pharmacy Guild of Australia president Kos Sclavos told Pharmacy eNews the AMA had insulted the profession by suggesting pharmacists were not capable of treating eye infections.
Mr. Sclavos said it was more to do with the Federal Government’s decision to approve medical continuance.
He told Pharmacy eNews: “I just can’t believe they’re coming out with this. This was flagged and people made submissions a year ago, it just shows how completely out of touch with process they are.
“These are short term therapies, obviously if muckyeye as a lot of patients refer to it, is not cleared up that person should be referred to the doctor.
“But here we have pharmacists studying for four years and the fifth year is an intern year, and it’s an insult to my profession to say that pharmacists are unable to treat that condition.
“The proof of the pudding is that New Zealand has rolled out successfully (Chloramphenicol as a pharmacist only treatment) and there’s been zero problems reported.
“It’s clear this has come out on the back of the medical continuance story,” he said.
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