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:
  • 50 to 100 mg/kg/day intravenous in divided doses 6 hourly to a maximum daily dose of 4 gms/day.

Chloramphenicol Dose in Childrens:

 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

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• Dose in Severe infections:
  • Infants, Children, and Adolescents:
    • 12.5 mg/kg/dose intravenous 6 hourly to a maximum dose of 4 gms/day. Some patients may require up to 25 mg/kg/dose 6 hourly. The dose should be reduced when the infection is controlled.

Pregnancy Risk Factor C

• Chloramphenicol crosses the placenta but teratogenic effects have not been observed in animal studies.
• "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:

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

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.
  • CBC should be frequently monitored and the drug should be immediately discontinued when signs of myelosuppression are observed.
  • 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.
• Intramuscular injections should be avoided. Intravenous push may be given at a concentration of 100 mg/mL or less. 

Mechanism of action of Chloramphenicol:

• It blocks protein synthesis by binding to the 50S subunits of susceptible organisms in a reversible manner.
• 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.

60% of the drug is bound Plasma proteins. 

It is Metabolized By the liver to inactivemetabolites.

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: