The present study was limited by its ecological nature, and consequently we were unable to identify factors that caused the increased and sustained supply of ophthalmic chloramphenicol OTC. It was likely that the removal of barriers such as the need to make a GP appointment, improved access and cost of travelling to and from doctor’s surgery provided sufficient incentive for people to practise self-care,[3] even if individuals had to purchase the treatment themselves in a country with no co-payment prescription levy. Sales could have been stimulated by promotional activities and, as a result, improved the public’s awareness of conjunctivitis and product availability. There was

a temporal relationship between OTC sales and items supplied on prescription, suggesting that patients with similar presentations were turning up at both community Crizotinib pharmacies and GP surgeries and were supplied ophthalmic chloramphenicol. This result needs to be interpreted with caution as it only

serves to demonstrate an association between the two variables rather than providing an explanation for them. To date there have been no published studies evaluating the appropriateness of prescribing or OTC supply of ophthalmic chloramphenicol in primary care, even if such criteria could be defined. Contrary to the trend of reduced prescribing for ophthalmic chloramphenicol reported in England,[26] the number of prescribed items for both eye drops and ointment in Wales remained similar despite the high volume of OTC sales following reclassification. RG7420 in vivo This observation could have been influenced by the abolition of the NHS prescription charge in Wales (April 2007), which may have encouraged patients to obtain a free prescription from their doctor. In England, where prescription co-payment was still in place, it was cheaper for patients who paid the prescription charge to purchase ophthalmic chloramphenicol OTC given that the average price of eye drops and ointment were £4.72 and £5.24, respectively, whereas the cost of a prescription item was £6.50 in 2005 and £7.40 in 2011. Our data demonstrated

that during the 12-month period (June 2007 to May 2008) after the abolition of prescription charge in Wales there was a small but distinguishable increase in eye drops dispensed on prescription, which PD184352 (CI-1040) is consistent with the observation made by others of an increase in prescription items following abolition of the co-payment charge.[27] This was not observed with the ointment over the same period but is probably because the market had not matured or stabilised. It has been suggested that the decrease in the number of items prescribed for chloramphenicol eye drops and ointment in England was due to a change in the management of conjunctivitis from empirical prescribing to no or delayed prescribing.[24] Whether or not prescribers in Wales adopted this approach is unknown.