How Specials Can Deliver Value to the NHS | Seite 8

CASE STUDY 1
Patient with an allergy to an eye
drop preservative

Background
A Special was required when a patient developed an allergy to
benzalkonium chloride, which was used as a preservative in a licensed
eye drop. The eye drops were used to treat bacterial infections of the eyelid
and eyeball, bacterial keratitis, and without treatment the patient could suffer
loss of sight or in the worst case, blindness. Bacterial keratitis can lead to vision
loss and is a sight-threatening process. A challenge with bacterial keratitis is its rapid
progression; corneal destruction may be complete in 24-48 hours with some of the more
virulent bacteria which means rapid diagnosis and treatment is critical to effectively preserve
sight. Allergy to benzalkonium chloride is well documented in the literature.

Patient with an allergy to eye drop preservative
LOWEST RISK/PREFERRED CHOICE

UK-licensed medicine
Off-label use of UK-licensed medicine

Patient developed allergy to preservative
in licensed preparation to treat bacterial
infection of eyelid and eyeball. Failure to
receive medication could result in blindness
within 48 hours and significant lifetime cost
to NHS and patient.

Imported product licensed in (approved) country of origin

UK-manufactured Special in
MHRA-licensed facilities
An extemporaneously dispensed medicine
An imported product not licensed in the country of origin
Crushing or splitting licensed tablets or capsules
A non-UK-made unlicensed medicine or food supplement

HIGHEST RISK/LAST CHOICE
Adapted from RPS practical guidelines on supplying Specials
Hierarchy may alter in particular patient groups; for example, neonates

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Preservative-free Special dispensed
within 24 hours and patient’s sight
was maintained