Chloramphenicol: Potent Broad-Spectrum Antibiotic Treatment
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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, specifically binding to the 50S ribosomal subunit. This medication is reserved for serious infections where other antibiotics are ineffective or contraindicated, due to potential risks such as bone marrow suppression. Available in oral, topical, and intravenous formulations, it remains a critical agent in specific clinical scenarios under careful medical supervision.
Features
- Broad-spectrum activity against aerobic and anaerobic Gram-positive and Gram-negative bacteria
- Available in oral, ophthalmic, topical, and intravenous formulations
- Rapid absorption and distribution throughout body tissues, including the central nervous system
- Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit
- Synthetic production ensures consistency and purity
Benefits
- Effective treatment for serious infections resistant to other antibiotics
- Penetrates well into cerebrospinal fluid, making it valuable for meningitis
- Useful in resource-limited settings due to low cost and wide availability
- Topical formulation provides targeted action for eye and skin infections
- Oral form allows for outpatient treatment of certain severe infections
- Rapid bacteriostatic action helps control infection progression
Common use
Chloramphenicol is typically prescribed for serious infections where less toxic alternatives are contraindicated or ineffective. Common applications include bacterial meningitis caused by Haemophilus influenzae, Neisseria meningitidis, or Streptococcus pneumoniae when penicillin cannot be used. It is also used for typhoid fever caused by Salmonella typhi, serious rickettsial infections, and anaerobic infections including brain abscesses. Ophthalmic preparations are commonly employed for bacterial conjunctivitis, while topical formulations address skin infections. Its use requires careful consideration of the infection severity, bacterial susceptibility, and patient-specific factors.
Dosage and direction
Dosage varies significantly based on formulation, infection severity, and patient factors. For systemic infections in adults: 50 mg/kg/day divided every 6 hours, not exceeding 4 g daily. For children: 50-75 mg/kg/day divided every 6 hours. Neonatal dosing requires careful calculation based on weight and gestational age. Ophthalmic solution: 1-2 drops in affected eye(s) every 3-6 hours. Topical application: apply thin layer to affected area 3-4 times daily. Always complete the full course of treatment even if symptoms improve. Administration timing should be consistent, with oral forms taken on an empty stomach for optimal absorption unless gastrointestinal upset occurs.
Precautions
Regular monitoring of complete blood counts is essential before and during treatment to detect early signs of bone marrow suppression. Use with caution in patients with hepatic or renal impairment, requiring possible dosage adjustment. Avoid unnecessary use to prevent development of bacterial resistance. Pregnancy category C: use only if potential benefit justifies potential risk to fetus. Nursing mothers should discontinue breastfeeding during treatment as chloramphenicol excretes in breast milk. Patients should report immediately any signs of infection, unusual bleeding, or fatigue. Genetic testing for G6PD deficiency may be indicated in certain populations.
Contraindications
Hypersensitivity to chloramphenicol or any component of the formulation. History of chloramphenicol-induced blood dyscrasias. Avoid concurrent use with other drugs that cause bone marrow suppression. Not recommended for trivial infections, prophylaxis, or viral infections. Contraindicated in patients with known glucose-6-phosphate dehydrogenase deficiency due to risk of hemolytic anemia. Avoid use in infants under 2 months except for life-threatening infections under strict monitoring.
Possible side effect
- Bone marrow suppression (dose-related reversible anemia or irreversible aplastic anemia)
- Gastrointestinal disturbances (nausea, vomiting, diarrhea)
- Gray baby syndrome in neonates (abdominal distension, cyanosis, cardiovascular collapse)
- Hypersensitivity reactions (rash, fever, angioedema)
- Optic neuritis with prolonged use (blurred vision, visual field defects)
- Peripheral neuropathy (especially with prolonged therapy)
- Superinfections due to altered normal flora
Drug interaction
- Concurrent use with other bone marrow suppressants (chemotherapeutic agents, zidovudine) increases hematologic toxicity
- May inhibit metabolism of warfarin, phenytoin, tolbutamide, and chlorpropamide, increasing their effects
- Barbiturates and rifampin may decrease chloramphenicol concentrations
- Antacids and iron preparations may reduce oral absorption
- May antagonize bactericidal activity of penicillins and aminoglycosides
- Alcohol consumption may cause disulfiram-like reaction
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. Maintain the regular dosing schedule. For ophthalmic or topical formulations, apply the missed dose when remembered unless close to next application time. Consistent antibiotic levels are important for effectiveness, so try to maintain regular dosing intervals. If multiple doses are missed, contact your healthcare provider for guidance.
Overdose
Symptoms of overdose include nausea, vomiting, altered mental status, and gray baby syndrome in infants. In cases of acute overdose, gastric lavage may be considered if presented early. Supportive care is mainstay, with particular attention to hematologic parameters. There is no specific antidote. Hemodialysis is not effective for removal due to high protein binding. In cases of suspected overdose, immediate medical attention is required with monitoring of complete blood counts regularly for several weeks.
Storage
Store at room temperature (15-30°C) in tightly closed containers. Protect from light and moisture. Do not freeze liquid formulations. Keep ophthalmic solutions sterile and discard within the recommended period after opening (typically 28 days). Keep all medications out of reach of children. Do not use beyond the expiration date. Do not transfer between containers. Store away from heat sources and direct sunlight. Oral suspensions should be shaken well before each use.
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. The prescribing healthcare professional must evaluate the benefit-risk ratio for each individual patient. Always follow the specific instructions provided by your healthcare provider and the product labeling. Do not self-medicate or share this medication with others. Report any adverse effects to your healthcare provider immediately.
Reviews
“Chloramphenicol remains our go-to antibiotic for multidrug-resistant typhoid cases in our region. While we monitor blood counts rigorously, its effectiveness in serious cases is unmatched when other options fail.” - Infectious Disease Specialist, 15 years experience
“Our ophthalmology department relies on chloramphenicol eye drops for bacterial conjunctivitis. The broad spectrum coverage and good tissue penetration make it highly effective, though we reserve it for cases where first-line options are unsuitable.” - Ophthalmologist, 8 years experience
“Having used chloramphenicol in tropical medicine practice, I appreciate its value in resource-limited settings. However, the risk of aplastic anemia requires careful patient selection and monitoring that isn’t always feasible in remote areas.” - Tropical Medicine Physician, 12 years experience