Sq Mycetin 1 gm/100 gm Eye Ointment

Broad-spectrum antibiotic. In Bangladesh mostly used as:

• Eye drops/ointment: bacterial conjunctivitis and superficial eye infections
• Ear drops: outer and middle ear infections (without perforated eardrum)
• Systemic (capsule/injection): reserved for serious infections when safer drugs cannot be used — typhoid fever, bacterial meningitis, rickettsial infections, brain abscess

Eye drops 0.5%: 1 drop every 2 hours for the first 2 days, then 1 drop four times daily; continue for 48 hours after healing (usually 5 days total).

Eye ointment 1%: apply at night (with drops in the day) or 3–4 times daily.

Ear drops 5%: 2–3 drops 2–3 times daily.

Systemic (adults and children): 50 mg/kg/day in 4 divided doses (up to 100 mg/kg/day in meningitis, reduce when possible).

• Neonates: reduced doses with blood level monitoring (risk of "grey baby syndrome").
• Systemic use only under medical supervision with blood count monitoring.

• Allergy to chloramphenicol
• History of blood disorders/bone marrow suppression, especially caused by chloramphenicol
• Porphyria
• Systemic use for minor infections, or for prevention

Eye drops: brief stinging, burning, blurred vision (ointment).

Systemic: nausea, vomiting, diarrhoea, dry mouth.

Rare but serious (systemic): bone marrow suppression — dose-related low blood counts, and rare irreversible aplastic anaemia (may occur even weeks after stopping, very rarely even with eye drops); grey baby syndrome in newborns; optic and peripheral neuritis with long use.

• Avoid repeated or prolonged courses.
• Systemic: blood counts before and during treatment; liver/kidney impairment needs lower dose.
• Contact lenses: remove during eye drop treatment.
• Report unusual bleeding, bruising, sore throat or fever.

Systemic use contraindicated in late pregnancy and breastfeeding (grey baby syndrome, bone marrow toxicity in infant). Eye drops: use only if necessary.

• Other bone-marrow-suppressing drugs: clozapine, carbamazepine, methotrexate, azathioprine (avoid)
• Warfarin, phenytoin, sulphonylureas, ciclosporin (levels rise)
• Rifampicin, phenobarbital (reduce chloramphenicol levels)
• Iron, vitamin B12 and folic acid (response may be reduced)

Systemic: bone marrow suppression, cardiovascular collapse (especially in neonates). Emergency treatment.

Eye drops: store in a refrigerator (2–8°C) before opening; after opening use within 4 weeks (store below 25°C). Capsules: below 30°C.