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Background: Fungal keratitis is a disease that has a low prevalence and poor outcome because of its minimal therapeutic spectrum. Objective:The purpose of the current study is to provide an overview of the use of antifungal topical eye drops in a third level hospital and to highlight possible improvements that can optimize their therapeutic use. Methods: Fungal keratitis cases treated in the Ophthalmology Department of a Tertiary hospital were reviewed in a four-year retrospective study.Results: For four years, 24 patients received an antifungal eye drop treatment for fungal keratitis: 20% were treated with topical fluconazole and 80% were treated with topical voriconazole (79% in monotherapy and 21% in conjunction with topical natamycin). In most cases, fungal growth was been detected and susceptibility was rarely reported, facilitating the realization of directed treatment towards the most frequently isolated fungi (Fusarium, Candida, Paecilomyces). Conclusion:In a disease with low prevalence and complicated management, we have detected improvement in the three involved departments: ophthalmology, pharmacy and microbiology.

Purpose Our aim was to prepare clozapine capsules, different strengths, macroscopically not discernible. Material and methods The consent of the patient and his parents had been obtained.In the absence of pure pharmaceutical raw material, the feasibility study (Good Preparation Practices) revealed crushability of the available tablets. They were micronised with a RETSCH RM 200 mortar apparatus for 4 min, particle size <3 mm.The initial prescription (one capsule 165 mg in the morning, one capsule 260 mg in the evening, for 15 days) led us to prepare 15 capsules of size 00 (translucent) for the morning and 15 capsules size 000 (opaque red) for the evening. Excipient (lactose) was added if required.The dose adjustment criterion was the clinical state of the patient.Results The obligations for labelling had been fulfilled except for the strength, replaced by morning clozapine or evening clozapine. The clinical evaluation induced a first increase (+12%) of the morning dose after 5 weeks.The correct dose was found after 9 weeks with +27% of the daily dose, targeted in the morning, without the patient's fear of the changes. White blood cell counts every 4 weeks were normal. At the last dose increase, the volume of the powder necessitated to change the capsules from 00 to 000 and ivory colour (instead of translucent, not available). Nevertheless, these macroscopic changes did not have a nocebo effect.Blinding required a double circuit of prescriptions: those given by the prescriber to the patient mentioning 'morning capsule: 1, evening capsule: 1' to be taken daily and those which were intended for us, specifying the strengths. Conclusion All items required in the pharmaceutical preparations labelling must be fulfilled exhaustively to avoid any confusion. However, exceptionally and transiently, a labelling not mentioning the strength was relevant in helping the prescriber to manage a dosage adjustment and to achieve the desired clinical outcomes.

BackgroundPhotochemotherapy is an effective treatment for psoriasis. The photosensitizer methoxsalen can be applied either orally or topically. When applied topically, the patient is immersed in a bath containing 0.0001% methoxsalen in warm water for 20 min, followed by UVA irradiation (PUVA bath (PUVAb)).Methoxsalen is very toxic and has carcinogenic effects when it is swallowed or gets in contact with mucosa. It must be handled with caution.PurposeTo find an effective and simple method for chemical deactivation of methoxsalen, which could be used in the clinical setting after PUVAb.Material and methodsMaterials: Methoxsalen powder, KOH, Ethanol, NaClO, CHCl3.Samples: 7 solutions of 200 mg of methoxsalen in 10 ml of ethanol.Reagents: 3 solutions of KOH (1 M, 0.5 M, 0.2 M), and 3 of NaClO (5%, 0.5%, 0.05% (v/v)).We mixed 10 ml of each reagent with a different methoxsalen sample and stirred. The seventh sample of methoxsalen was used as a blank.We monitored the chemical reactions with thin layer chromatography at 10 and 30 min. Mobile phase was ethanol 1% in CHCl3. We used UV light to visualise the chromatogram.We performed a qualitative analysis of the remaining methoxsalen in each sample, after acid or alkaline hydrolysis.ResultsThe blank showed that methoxsalen is completely eluted by the mobile phase. In the six samples, we observed that part of the mixture is eluted (methoxsalen), while other compounds are retained in the stationary phase. These may be polar degradation products. The more concentrated the reagents, the smaller the quantity of methoxsalen remaining. The most extensive hydrolysis was seen in the mixture with 1M KOH.ConclusionBoth KOH and HClO hydrolyse methoxsalen. The most efficient reactive was 1M KOH, which hydrolysed almost the whole sample.These results suggest that KOH 1M may be useful to deactivate methoxsalen after PUVAb, although further studies are necessary to characterise degradation products and evaluate their toxicity.References and/or acknowledgementsNo conflict of interest.