Chloramphenicol may be used rarely for serious infections

Chloramphenicol inhibits bacterial protein synthesis. It is widely used for topical purposes in the form of eye and ENT drops and ointments. Systemic use of chloramphenicol is limited because of the serious adverse effects like bone marrow suppression associated with its use. It is used to treat the following conditions:

  • Serious infections including exacerbations of cystic fibrosis, bacterial meningitis, and bacteremia caused by the following organisms when other drugs are contraindicated or ineffective.
    • Chlamydiaceae
    • Haemophilus influenza
    • Rickettsia
    • Salmonella spp.  and
    • other organisms

Chloramphenicol should be used with caution in tickborne rickettsial diseases

Chloramphenicol Dose in Adults

  • Dose in Serious infections:
    • A maximum daily dose of 4 gms/day is administered intravenously in divided doses of 50 to 100 mg/kg/day every 6 hours.

Chloramphenicol Dose in Children:

 Note: Chloramphenicol should never be used as a first line of therapy. Less toxic medicines should be tried first. If used in patients with serious infections, follow serum levels to monitor toxicity

  • Dose in Meningitis:
    • Infants, Children, and Adolescents:
      • 18.75-25 mg/kg/dose intravenous every 6 hours
  • Dose in Severe infections:
    • Infants, Children, and Adolescents:
      • 4 g of 12.5 mg/kg/dose IV medication per day at a maximum dose. Some patients can need up to 25 mg/kg/dose given every six hours. When the infection is under control, the dose should be decreased.

Pregnancy Risk Factor C

  • Chloramphenicol crosses the placenta, although investigations on animals have not revealed any teratogenic consequences.
  • "Gray baby Syndrome" has occurred in newborns and premature infants receiving chloramphenicol. It should be used with caution in the third trimester of pregnancy.

Use during breastfeeding:

  • It is excreted in breastmilk and is not compatible with breastfeeding. the manufacturer recommends avoiding the drug or discontinuing breastfeeding while using chloramphenicol.
  • Maternal antibiotics may alter the infants gut flora and result in a gastric upset, hemolysis, and jaundice

Chloramphenicol Dose in Renal Disease:

Although the manufacturer does not advise dose adjustments for patients with renal disease, severe renal impairment should be handled carefully, and serum levels should be kept track of.

Chloramphenicol Dose in Liver Disease:

 The manufacturer has not recommended any dose adjustment in patients with liver disease, however, it should be used with caution in liver disease and the serum levels should be monitored.

Common Side Effects of Chloramphenicol:

  • Central nervous system:
    • Confusion,
    • Delirium,
    • Depression,
    • Headache
  • Dermatologic:
    • Skin rash,
    • Urticaria
  • Gastrointestinal:
    • Diarrhea,
    • Enterocolitis,
    • Glossitis,
    • Nausea,
    • Stomatitis,
    • Vomiting
  • Hematologic & oncologic:
    • Aplastic anemia,
    • Bone marrow depression,
    • Granulocytopenia,
    • Hypoplastic anemia,
    • Pancytopenia,
    • Thrombocytopenia
  • Hypersensitivity:
    • Anaphylaxis,
    • Angioedema,
    • Hypersensitivity reaction
  • Ophthalmic:
    • Optic neuritis
  • Miscellaneous:
    • Drug toxicity (Gray syndrome),
    • Fever

Contraindication to Chloramphenicol include:

  • Allergy or sensitivity to chloramphenicol, or any component of this formulation
  • Treatment for trivial bacterial or viral infections
  • To prevent bacterial infection.

Warnings and Precautions

  • Blood dyscrasias[US Boxed Warning]
    • Chloramphenicol use has been linked to severe bone marrow suppression, including hypoplastic anemia and thrombocytopenia.
    • This agent should only be used in severe infections where other treatments are not effective or contraindicated.
    • When myelosuppression symptoms are noticed, the CBC should be regularly evaluated, and the medication should be stopped very away.
    • It is also important to avoid repeating the same course.
  • Gray syndrome:
    • It can be characterized by cyanosis and abdominal distention, hypotension and irregular respiration.
  • Superinfection
    • Patients who have received the drug for a long time may develop fungal or bacterial superinfections, such as C. difficile-associated diarrhea(CDAD), and pseudomembranous collitis.
  • Hepatic impairment
    • Patients suffering from liver disease should be cautious when taking the drug.
  • Renal impairment
    • Patients with kidney disease should be cautious when using the drug and keep an eye on their serum levels.

Chloramphenicol: Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).

Alcohol (Ethyl) Chloramphenicol Systemic may increase the toxic/adverse effects of Alcohol (Ethyl).
BCG Vaccine (Immunization) Antibiotics may lessen the benefits of the BCG vaccine (Immunization).
Carbocisteine The adverse/toxic effects of Carbocisteine may be increased by Systemic chloramphenicol. Specifically, chloramphenicol may enhance adverse effects of alcohol that is present in liquid formulations of carbocisteine-containing products.
Chloramphenicol (Ophthalmic) May increase the toxic/adverse effects of Myelosuppressive Agents.
CloZAPine CloZAPine's toxic/adverse effects may be exacerbated by myelosuppressive agents. Particularly, there may be an increase in the risk of neutropenia.
Fosphenytoin Could result in a drop in chloramphenicol serum concentrations. Chloramphenicol Systemic levels in the serum can rise when fosphenytoin is taken. Chloramphenicol Systemic may raise the serum levels of fosphenytoin.
Lactobacillus & Estriol Antibiotics can reduce the therapeutic effects of Lactobacillus or Estriol.
Phenytoin Could lower the serum level of systemic chloramphenicol. Phenytoin may raise the serum levels of chloramphenicol (Systemic). Chloramphenicol may raise the serum levels of phenytoin and chloramphenicol systemic.
Promazine May increase the myelosuppressive effects of Myelosuppressive Drugs.
Sulfonylureas Chloramphenicol (Systemic), may reduce the metabolism of sulfonylureas.
Vitamin B12 Vitamin B12 may be affected by Chloramphenicol (Systemic).
Vitamin K antagonists (eg warfarin) Chloramphenicol Systemic may intensify Vitamin K Antagonists' anticoagulant effects. Chloramphenicol Systemic may raise the serum level of Vitamin K antagonists.
Voriconazole Systemic Chloramphenicol may raise the serum levels of voriconazole.

Risk Factor D (Insist on therapy modification)

 
Barbiturates The metabolism of Barbiturates may be affected by Chloramphenicol Systemic. The metabolism of Chloramphenicol Systemic may be increased by Barbiturates.
CefTAZidime The therapeutic effects of CefTAZidime may be diminished by Chloramphenicol Systemic. Management: If you require bactericidal activity, consider using another combination of antimicrobials. Monitor for decreased antimicrobial effectiveness or therapeutic failure if these agents are used together.
CycloSPORINE Systemic The serum level of CycloSPORINE Systemic may be increased by Chloramphenicol (Systemic). Concurrent chloramphenicol: Cyclosporine dose reductions may be necessary. After initiation or discontinuation of chloramphenicol, closely monitor cyclosporine levels and responses.
RifAMPin May increase metabolism of Chloramphenicol Systemic
Sodium Picosulfate The therapeutic effects of sodium picosulfate can be diminished by antibiotics. Patients who are taking antibiotics or who have recently stopped taking them should think about using an alternative medication to clean their bowels before a colonoscopy.
Tacrolimus (Systemic) Chloramphenicol use while taking Systemic may result in an increase in the serum concentrations of Tacrolimus (Systemic) (Systemic). Chloramphenicol taken concurrently: Tacrolimus dosage adjustments may be required. Maintain close watch on tacrolimus levels after starting or stopping chloramphenicol.
Typhoid Vaccine The therapeutic effects of Typhoid vaccine may be diminished by antibiotics. The only affected strain is the live attenuated Ty21a. Patients being treated with systemic antibiotics should avoid vaccination with live attenuated Typhoid vaccine (Ty21a). 

Risk Factor X (Avoid Combination)

 
BCG (Intravesical). Antibiotics may lessen the therapeutic effects of BCG (Intravesical).
BCG (Intravesical). The therapeutic effects of BCG may be diminished by myelosuppressive medications (Intravesical).
Cholera Vaccine Antibiotic use may reduce the effectiveness of the cholera vaccine. Treatment: Patients who have taken systemic antibiotics should not receive the cholera vaccination.
Cladribine May increase the myelosuppressive effects of myelosuppressive agents.
Deferiprone Deferiprone may have a neutropenic effect that myelosuppressive agents can increase.
Dipyrone May increase the toxic/adverse effects of Myelosuppressive Agents. In particular, there may be an increase in the risk of pancytopenia and agranulocytosis.

How to administer Chloramphenicol?

  • It should be administered as a slow intravenous infusion.
  • Injections intramuscularly ought to be avoided. One can administer intravenous push at a concentration of 100 mg/mL or less.

Mechanism of action of Chloramphenicol:

  • It inhibits protein synthesis by reversibly binding to the 50S subunits of sensitive species.
  • This prevents amino acids from being transferred to growing proline chains and it also inhibits their ability to produce new proteins.

It is Widely distributed Access to the cerebrospinal area & the brain is possible for most tissues and organs.

Plasma proteins bind 60% of the medication.

The liver converts it into inactive metabolites.

The Half-life elimination It can vary from 24 hours for neonates to 4 hours for adults.

International Brands in Chloramphenicol:

  • Abefen
  • Aglomycetin
  • Alfa Cloromicol
  • Almycetin
  • Amphen
  • Anpechlor
  • Arifenicol
  • Armisetin
  • Beaphenicol
  • Biophenicol
  • Brocil
  • CPhenicol
  • Cebenicol
  • Chemicetina
  • Chemycetin
  • Chloram-P
  • Chloramex
  • Chloranic
  • Chlorchol
  • Chlorcol
  • Chlornicol
  • Chlornitromycin
  • Chlorphen
  • Cidocetine
  • Clorafen
  • Cloramidina
  • Colsancetine
  • Decol
  • Enclor
  • Euchlor
  • Fencol
  • Gemysetin
  • Gerafen
  • Grafacetin
  • Helocetin
  • Kalmicetine
  • Kemicetine
  • Labchlor
  • Levocol NASR
  • Levomycetin
  • Medophenicol
  • Mephicetine
  • Neosechinbi
  • Ofenicol
  • Pharmaxin
  • Phenicol
  • Quemicitina
  • Reclor
  • ShuEr
  • Sintomicetina
  • Soluparaxin
  • Solupraxin
  • Synthomycin
  • Synthomycine
  • Type-S
  • Vixmicina
  • Xepanicol

Chloramphenicol Brands in Pakistan:

Chloramphenicol[Inj 1 g]

ChloramphenicolInjection LAHORE CHEMICAL & PHARMACEUTICAL WORKS (PVT) LTD
ChloramphenicolInjection BOSCH PHARMACEUTICALS (PVT) LTD.
ChloramphenicolInjection AMROS PHARMACEUTICALS.
ChloramphenicolInjection SAFE PHARMACEUTICAL (PVT) LTD.
CHLOROMAX PHARMEDIC (PVT) LTD.
CHLOROMED MEDICRAFT PHARMACEUTICALS (PVT) LTD.
CHLOROPHENICOL PLIVA PAKISTAN (PVT) LIMITED
ELKOPHENICOL S ELKO ORGANIZATION (PVT) LTD.

Chloramphenicol[Drops 1 %w/v]

BIOMYCINE SHAREX LABORATORIES (PVT.) LTD.
DILOCAL ZINTA PHARMACEUTICALS INDUSTRIES

Chloramphenicol[Drops 0.3 %w/v]

NEOBREX P.D.H. PHARMACEUTICALS (PVT) LTD.

Chloramphenicol[Drops 0.5 %w/v]

VEGACHLOR VEGA PHARMACEUTICALS LTD.

Chloramphenicol[Eye Drops 1 %w/v]

Chloramphenicoleye drops DOSACO LABORATORIES
Chloramphenicoleye drops AMROS PHARMACEUTICALS.
MANOPHENICOL MACQUINS INTERNATIONAL

Chloramphenicol[Eye Drops 0.5 %w/v]

Chloramphenicoleye drops SHIFA LABORATORIES.(PVT) LTD.
Chloramphenicoleye drops IRZA PHARMA (PVT) LTD.
CHLOROPTIC BARRETT HODGSON PAKISTAN (PVT) LTD.
CLORAMIDINA PAKISTAN PHARMACEUTICAL PRODUCTS (PVT) LTD.
ECONOCHLOR AGP (PRIVATE) LTD.
EPOPHENICOL EPOCH PHARMACEUTICAL
EYCHLOR ORIENT LABORATORIES
EYCHLOR ORIENT LABORATORIES
FENOPTIC HELIX PHARMA (PRIVATE) LIMITED
INVOCLOR INNVOTEK PHARMACEUTICALS
LEXICOL JAENS PHARMA
MANOPHENICOL MACQUINS INTERNATIONAL
MB-CHLOR MULTINATIONAL BUISNESS LINK
MEDICHLOR PLUS MEDIPAK LIMITED
NEO-PHENICOL P.D.H. PHARMACEUTICALS (PVT) LTD.
O-MYCETIN AZRON PHARMACEUTICALS (PVT) LTD
OPCHLOR EPHARM LABORATORIES
OPHTH-CHLOR OPHTH-PHARMA (PVT) LTD.
OPTACHLOR REMINGTON PHARMACEUTICAL INDUSTRIES (PVT) LTD.
ORBACHLOR ZAFA PHARMACEUTICAL LABORATORIES (PVT) LTD.
ORICOL REX PHARMACEUTICALS PAKISTAN
SANTOCHLOR SANTE (PVT) LIMITED
SCHAZOMYCETIN THE SCHAZOO LABORATORIES LTD.
SIFICETINA NEO MEDIX
SPERSANICOL NOVARTIS PHARMA (PAK) LTD
VASOCHLOR ETHICAL LABORATORIES (PVT) LTD.
VITACHLOR MEDIPAK LIMITED

Chloramphenicol[Ear Drops 1 %w/v]

Chloramphenicolear drops ETHICAL LABORATORIES (PVT) LTD.
Chloramphenicolear drops IRZA PHARMA (PVT) LTD.
Chloramphenicolear drops PHARMAWISE LABS. (PVT) LTD.
EPOPHENICOL EPOCH PHARMACEUTICAL
MB-CHLOR MULTINATIONAL BUISNESS LINK
NEO-PHENICOL P.D.H. PHARMACEUTICALS (PVT) LTD.
REMICOL REMINGTON PHARMACEUTICAL INDUSTRIES (PVT) LTD.

Chloramphenicol[Ear Drops 0.5 %w/v]

Chloramphenicolear drops SHIFA LABORATORIES.(PVT) LTD.
Chloramphenicolear drops DOSACO LABORATORIES

Chloramphenicol[Eye Oint 1 %w/w]

BENTHAPHEN TRIGON PHARMACEUTICALS PAKISTAN (PVT) LTD.
CHLORAMPHENICOL LAHORE CHEMICAL & PHARMACEUTICAL WORKS (PVT) LTD
CHLORAX ELITE PHARMA
CHLORAX ELITE PHARMA
GEOCLOR GEOFMAN PHARMACEUTICALS
NEO-PHENICOL P.D.H. PHARMACEUTICALS (PVT) LTD.
NOVOPHENICOL KRKA-PAK PHARMACEUTICAL & CHEMICAL WORKS
OPTACHLOR REMINGTON PHARMACEUTICAL INDUSTRIES (PVT) LTD.
SANTOCHLOR SANTE (PVT) LIMITED
SIFICETINA NEO MEDIX

Chloramphenicol[E and E Drops 0.5 %w/v]

ChloramphenicolDrops AMROS PHARMACEUTICALS.
EROPHENICOL EROS PHARMACEUTICALS
EROPHENICOL EROS PHARMACEUTICALS
KLORECAL ZINTA PHARMACEUTICALS INDUSTRIES

Chloramphenicol[Susp 25 mg/5ml]

MONCOL ALKEMY PHARMACEUTICAL LABORATORIES (PRIVATE) LTD.

Chloramphenicol [Susp 125 mg/5ml]

Chloramphenicolsuspension SHIFA LABORATORIES.(PVT) LTD.
Chloramphenicolsuspension POLYFINE CHEMPHARMA (PVT) LTD.
Chloramphenicolsuspension UNISON CHEMICAL WORKS
Chloramphenicolsuspension KRKA-PAK PHARMACEUTICAL & CHEMICAL WORKS
Chloramphenicolsuspension Lahore Chemical & Pharmaceutical works (PVT) LTD
Chloramphenicolsuspension DOSACO LABORATORIES
Chloramphenicolsuspension AMROS PHARMACEUTICALS.
Chloramphenicolsuspension JAWA PHARMACEUTICALS(PVT) LTD.
Chloramphenicolsuspension ELKO ORGANIZATION (PVT) LTD.
CHLOROFEN FEROZSONS LABORATOIES LTD.
CHLOROGEN GENERA PHARMACEUTICALS
CHLOROMYCETIN PALMITATE PFIZER LABORATORIES LTD.
EPOPHENICOL EPOCH PHARMACEUTICAL
EPOPHENICOL EPOCH PHARMACEUTICAL
IRZAPHENICOL IRZA PHARMA (PVT) LTD.
KOHSCLOR KOHS PHARMACEUTICALS
LISKOMYCETIN LISKO PAKISTAN (PVT) LTD
M-PHENICOL MUNAWAR PHARMA (PVT) LTD.
MB-CHLOR MULTINATIONAL BUISNESS LINK
NEO-PHENICOL P.D.H. PHARMACEUTICALS (PVT) LTD.
NOVOPHENICOL KRKA-PAK PHARMACEUTICAL & CHEMICAL WORKS
PHENICHLOR HAMAZ PHARMACEUTICAL (PVT) LTD.
PHENICOL PHARMAWISE LABS. (PVT) LTD.
SEMOFENICOL SEMOS PHARMACEUTICALS (PVT) LTD.
UNIPHENICOL UNISON CHEMICAL WORKS

Chloramphenicol[Oint 1 %w/w]

INVOCLOR INNVOTEK PHARMACEUTICALS

Chloramphenicol[Oint 0.3 %w/w]

NEOBREX P.D.H. PHARMACEUTICALS (PVT) LTD.

Chloramphenicol[Oint 0.5 %w/w]

CLORAMIDINA PAKISTAN PHARMACEUTICAL PRODUCTS (PVT) LTD.

Chloramphenicol[Tabs 250 mg]

MAVICHLOR MULTINATIONAL BUISNESS LINK

Chloramphenicol[Caps 250 mg]

ChloramphenicolCapsules GEOFMAN PHARMACEUTICALS
ChloramphenicolCapsules IRZA PHARMA (PVT) LTD.
ChloramphenicolCapsules LAHORE CHEMICAL & PHARMACEUTICAL WORKS (PVT) LTD
ChloramphenicolCapsules LISKO PAKISTAN (PVT) LTD
CHLOROGEN GENERA PHARMACEUTICALS
CHLOROMYCETIN PFIZER LABORATORIES LTD.
CHLOROPHENICOL PLIVA PAKISTAN (PVT) LIMITED
EPOPHENICOL EPOCH PHARMACEUTICAL
FENICOL UNEXO LABS (PVT) LTD.
MEDCLOR MEDERA PHARMACEUTICALS (PVT) LTD.
NOVOPHENICOL KRKA-PAK PHARMACEUTICAL & CHEMICAL WORKS
SEMOFENICOL SEMOS PHARMACEUTICALS (PVT) LTD.

Chloramphenicol[Caps 500 mg]

CHLOROMYCETIN FORTE PFIZER LABORATORIES LTD.