Information about Chloramphenicol
Chloramphenicol is a broad spectrum antibiotic introduced into clinical practice in 1948, but which was subsequently shown to cause serious and fatal aplastic anemia and is now used rarely and reserved for severe, life-threatening infections for which other antibiotics are not available.
Liver safety of Chloramphenicol
Chloramphenicol has also been linked to cases of acute, clinically apparent liver injury with jaundice, largely in association with aplastic anemia.
History of Chloramphenicol
FDA approval information for Chloramphenicol
Chloramphenicol was introduced into clinical practice in 1948 under the brand name Chloromycetin and became a widely used antibiotic because of its oral availability, excellent tolerability and wide spectrum of activity.
Clinical use of Chloramphenicol
Chloramphenicol has bacteriostatic activity against many gram positive and gram negative organisms, both aerobic and anaerobic including H. influenza, N meningitides, S. pneumoniae, N gonorrhoeae, Brucella species and Bordetella pertussis. It also has activity against many spirochaetes, rickettsiae, chlamydiae and mycoplasmas.
Mechanism of action of Chloramphenicol
Chloramphenicol is thought to act by binding to the 50S ribosomal subunit in bacteria, thus inhibiting bacterial protein synthesis. A similar inhibition of protein synthesis may occur in mitochondria.
Side effects of Chloramphenicol
Within a few years of its introduction, chloramphenicol was linked to rare cases of aplastic anemia and later to other fatal blood dyscrasias including thrombocytopenia, neutropenia and pure red cell aplasia.
In addition, cases of leukemia were identified in children who had recovered from blood dyscrasias attributed to chloramphenicol. By the early 1960s, more than 1000 cases of severe bone marrow aplasia were attributed to use of chloramphenicol and it was widely banned or placed under restrictions, particularly in children.
Dosage and administration for Chloramphenicol
Currently, chloramphenicol is available only in parenteral forms, and its use is restricted to severe, life-threatening infections for which no other antibiotic is available because of antibiotic resistance or drug allergy. Several generic forms of chloramphenicol for intravenous administration are available and the recommended dose is 50 mg/kg daily in 4 divided doses.
Monitoring of blood counts