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

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: