Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).

• Contact lenses should not be worn during treatment.
• Prescribe preservative-free chloramphenicol eye drops if the person cannot avoid wearing contact lenses (some preservatives such as benzalkonium chloride accumulate in soft contact lenses and cause irritation).
• Do not prescribe eye ointment if contact lenses are worn.
• Do not use topical chloramphenicol:
• For people who have experienced myelosuppression during previous exposure to chloramphenicol.
• For people who have a blood dyscrasia, or who have a family history of blood dyscrasias.
• Concurrently with other myelotoxic drugs.
• For prolonged periods, since it may increase the likelihood of sensitization and resistance.
• Aplastic anaemia and bone marrow depression is extremely rare, and concerns about the increased risk of this adverse effect have not been proven.

[ABPI Medicines Compendium, 2007a; ABPI Medicines Compendium, 2007b; BNF 54, 2007; ABPI Medicines Compendium, 2008]

• Adverse effects are usually minor, such as transient stinging or a burning sensation in the eye. Do not drive or operate machinery unless your vision is clear.
• Do not wear contact lenses during treatment or if untreated infection is present. Avoid soft contact lenses until at least 24 hours after treatment has been completed.
• If two different eye-drop preparations are used at the same time of day, leave an interval of at least 5 minutes between application of the two types. This will help prevent any dilution and overflow that may occur if application of one preparation immediately follows another.

[ABPI Medicines Compendium, 2001; ABPI Medicines Compendium, 2007a; ABPI Medicines Compendium, 2007b; BNF 54, 2007; ABPI Medicines Compendium, 2008]

• Adverse effects are usually minor, such as transient stinging or a burning sensation in the eye.

[ABPI Medicines Compendium, 2001; BNF 54, 2007]

• Topical fusidic acid may be used during pregnancy or when breastfeeding.
• Topical chloramphenicol may also be used during breastfeeding. However it is not recommended during pregnancy [UKMiCentral, 2004; Schaefer et al, 2007].

• Fusidic acid is not known to be harmful when used during pregnancy or breastfeeding [BNF 54, 2007].
• There is no evidence that chloramphenicol is associated with congenital abnormalities. However maternal treatment with chloramphenicol in the last few weeks of pregnancy may cause grey baby syndrome (feeding problems, vomiting, ash-grey skin, respiratory distress, and cardiovascular collapse [Micromedex, 2007]).

• Do not use paracetamol for:
• People with hepatic impairment or alcohol dependence, as there is increased risk of liver damage.
• Do not use ibuprofen for:
• People with a history of hypersensitivity to nonsteroidal anti-inflammatory drugs ([NSAIDs] e.g. bronchospasm, asthma, rhinitis, or urticaria known to have been precipitated by an NSAID).
• People with peptic ulcers or at high risk of gastrointestinal bleeding or ulceration.
• People taking ciclosporin, lithium, methotrexate, or other NSAIDs.
• If possible, avoid ibuprofen for:
• People with hypertension, heart failure, or renal impairment. Ibuprofen can worsen or precipitate these conditions.
• Pregnant (particularly in the third trimester) or breastfeeding women.
• People taking antihypertensives, digoxin, oral corticosteroids, or warfarin.

• The contraindications, cautions, and interactions information is based on the relevant summaries of product characteristics [ABPI Medicines Compendium, 2005; ABPI Medicines Compendium, 2007c].

• Where possible, paracetamol is preferred to ibuprofen during pregnancy and breastfeeding.
• Experience suggests that paracetamol can be used at any time during pregnancy or breastfeeding [NTIS, 2004; Schaefer et al, 2007].
• If anti-inflammatory treatment is needed, short-term use of ibuprofen can be considered during the first and second trimester. However, it should be avoided in the third trimester (30 weeks onwards) because of the risk of causing premature closure of the ductus arteriosus, or decreasing the amniotic fluid volume [NTIS, 2004; Schaefer et al, 2007]. Levels of ibuprofen excreted in breast milk are negligible [Trent Drug Information Services, 2005].
• Further information can be obtained on:
• Pregnancy: contact the UK Teratology Information Service (UKTIS), formerly the National Teratology Information Service (NTIS), on 0844 892 0909.
• Breastfeeding: see the UK Drugs in Lactation Service website, or telephone 0121 311 1974.