Chloramphenicol is a bacteriostatic antibiotic with a broad spectrum of activity against both Gram-positive and Gram-negative bacteria, as well as certain other microorganisms. It functions by inhibiting bacterial protein synthesis, binding to the 50S ribosomal subunit and preventing peptide bond formation. This medication is reserved for serious infections where other antibiotics are ineffective or contraindicated, due to its potential for severe adverse effects. Proper medical supervision is essential throughout treatment.

Features

• Broad-spectrum antibiotic effective against a wide range of bacteria
• Available in oral, topical, and intravenous formulations
• Rapid absorption and distribution throughout body tissues
• Inhibits bacterial protein synthesis at the ribosomal level
• Can penetrate into cerebrospinal fluid, making it useful for certain CNS infections

Benefits

• Provides effective treatment for serious, multidrug-resistant bacterial infections
• Offers rapid bactericidal action in high concentrations
• Demonstrates excellent tissue penetration, including ocular and central nervous system
• Useful when penicillin allergies prevent use of alternative antibiotics
• Effective against anaerobic organisms and rickettsial diseases
• Can be life-saving in cases of typhoid fever and bacterial meningitis

Common use

Chloramphenicol is primarily used for serious infections caused by susceptible organisms when less potentially dangerous drugs are ineffective or contraindicated. These include typhoid fever, bacterial meningitis, rickettsial diseases, and serious infections involving Bacteroides fragilis. It is also used topically for eye infections such as bacterial conjunctivitis. Due to its potential for serious adverse effects, it is generally not used for minor infections or as a first-line treatment.

Dosage and direction

Dosage must be individualized based on the infection severity, organism susceptibility, and patient factors. For adults, typical oral dosage is 50 mg/kg/day divided into 4 equal doses. For severe infections, this may be increased to 100 mg/kg/day. Intravenous administration requires similar dosing. Topical ophthalmic preparations are typically applied every 3-6 hours. Treatment duration should be as short as possible to minimize adverse effects, usually 5-14 days depending on infection type and response.

Precautions

Regular monitoring of complete blood counts is essential before and during therapy due to risk of bone marrow suppression. Liver and kidney function should be assessed periodically. Use with extreme caution in patients with hepatic or renal impairment, as dosage adjustments may be necessary. Avoid unnecessary use as it may promote development of drug-resistant bacteria. Patients should be advised to report any signs of infection, unusual bleeding, or fatigue immediately.

Contraindications

Chloramphenicol is contraindicated in patients with known hypersensitivity to the drug. It should not be used for trivial infections, as prophylaxis, or for infections treatable with other antimicrobial agents. Avoid use in patients with pre-existing bone marrow depression or blood dyscrasias. Contraindicated in neonates, particularly premature infants, due to risk of “gray baby syndrome.” Not recommended during pregnancy unless absolutely necessary.

Possible side effect

The most serious adverse effect is bone marrow suppression, which may be dose-related and reversible or idiosyncratic and fatal. Hematologic effects include aplastic anemia, thrombocytopenia, and leukopenia. Gastrointestinal disturbances such as nausea, vomiting, and diarrhea are common. Neurologic effects include optic and peripheral neuritis. Hypersensitivity reactions may occur. Gray baby syndrome in neonates features cardiovascular collapse, cyanosis, and death. Superinfections with nonsusceptible organisms may develop.

Drug interaction

Chloramphenicol may potentiate effects of oral anticoagulants, requiring dosage adjustment. It may increase blood levels of phenytoin, tolbutamide, and chlorpropamide. Concurrent use with other bone marrow suppressants increases hematologic toxicity risk. Barbiturates may reduce chloramphenicol levels. It may antagonize bactericidal activity of penicillins and aminoglycosides. Avoid concurrent administration with drugs metabolized by hepatic microsomal enzymes.

Missed dose

If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next dose, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one. Maintaining consistent blood levels is important for effectiveness, so patients should try to adhere to the prescribed dosing schedule as closely as possible.

Overdose

Symptoms of overdose include nausea, vomiting, and gray baby syndrome in infants. In severe cases, cardiovascular collapse may occur. Treatment is supportive and symptomatic. Hemodialysis may be effective in removing the drug. In cases of recent ingestion, gastric lavage may be considered. Blood counts should be monitored closely for several weeks following overdose due to risk of delayed bone marrow suppression.

Storage

Store at room temperature between 15-30°C (59-86°F). Protect from light and moisture. Keep tightly closed in original container. Do not freeze oral or intravenous formulations. Keep out of reach of children and pets. Do not use after expiration date. Properly discard any unused medication after treatment completion. Do not flush medications down the toilet or pour into drain unless instructed to do so.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Chloramphenicol is a prescription medication that should only be used under direct medical supervision. Healthcare professionals must weigh potential benefits against risks before prescribing. Patients should not self-medicate with this drug. Always consult a qualified healthcare provider for diagnosis and treatment recommendations specific to your medical condition.

Reviews

“Chloramphenicol remains a critical antibiotic in our arsenal against multidrug-resistant organisms. While its hematologic risks are significant, when used appropriately in monitored settings, it can be life-saving for infections where alternatives have failed.” - Infectious Disease Specialist

“In ophthalmology, chloramphenicol eye preparations continue to be effective for bacterial conjunctivitis, though we reserve them for cases where first-line treatments are unsuitable. The risk-benefit ratio must be carefully considered for each patient.” - Ophthalmologist

“Proper patient monitoring is absolutely essential with chloramphenicol therapy. We implement strict protocols for blood count surveillance and patient education about warning signs of hematologic toxicity.” - Clinical Pharmacist