II. Indications

  1. Rare use in the United States (due to adverse effects)
  2. Avoid unless other Antibiotics have failed and infection has known susceptibility to Chloramphenicol
  3. Bacteriostatic Activity
    1. Gram Positive Bacteria
    2. Gram Negative Bacteria
    3. Anaerobic Bacteria
  4. Conditions: Topical Use
    1. Bacterial Conjunctivitis
    2. Otitis Externa (risk of Ototoxicity)
    3. Surgical Wound Infection prophylaxis
  5. Conditions: Life-threatening Infections
    1. Typhoid Fever
    2. Rickettsial infections
    3. Meningitis
      1. HaemophilusInfluenzae
      2. Neisseria Meningitidis
      3. Streptococcus Pneumoniae

III. Contraindications

  1. Acute porphyria
  2. G6PD Deficiency
  3. Young Infants (esp. Preterm Infants) or lactating mothers
    1. Grey baby Syndrome risk (see below)

IV. Mechanism

  1. First identified in 1948 and was among the first synthetic Antibiotics
  2. Semisynthetic broad spectrum, Bacteriostatic Antibiotic derived from Streptomyces venequelae
  3. Inhibits Bacterial Protein synthesis
    1. Diffuses across the Bacterial cell wall and reversibly binds the Bacterial 50S Ribosome
    2. Inhibits peptidyl transferase activity at the tRNA ribosomal attachment A site
    3. Blocks transfer to Amino Acids to a growing polypeptide chain

V. Dosing: Serious, Life threatening Infections

  1. Adult (e.g. Typhoid Fever, Rickettsial infection)
    1. Give 50 mg/kg/day divided every 6 hours IV
    2. Doses as high as 75 to 100 mg/kg/day may be needed for organisms resistant to other agents
    3. Decrease dose in hepatic dysfunction: 1 g IV load, then 500 mg every 6 hours
  2. Child (e.g. Meningitis)
    1. Give 50 to 100 mg/kg/day divided every 6 hours IV
    2. Doses as high as 75 to 100 mg/kg/day may be needed for organisms resistant to other agents (esp. Pneumococcus)

VI. Adverse Effects

  1. Ototoxicity (Ear Drops)
  2. Esophagitis
  3. Neurotoxicity (includes Optic Neuritis)
  4. Metabolic Acidosis
  5. Blood Dyscrasias and Marrow Suppression
    1. Type 1: Reversible, dose-dependent mild Anemia, Thrombocytopenia, Neutropenia
    2. Type 2: Idiosyncratic Pancytopenia or Aplastic Anemia
      1. Deaths have occurred
      2. More common when taken with Cimetidine
    3. Other uncommon to rare effects
      1. Secondary Leukemia
  6. Grey baby Syndrome
    1. Presents with grey Skin Color, poor feeding, irritability, Vomiting, Abdominal Distention, cardiovascular collapse
    2. High mortality (up to 40%)

VII. Safety

  1. Avoid in pregnancy (despite pregnancy category C)
  2. Avoid in Lactation
    1. Grey baby Syndrome risk
  3. Monitoring
    1. Complete Blood Count (CBC) every 2 days
    2. Serum drug levels
      1. Therapeutic peak: 10 to 20 mcg/ml
      2. Therapeutic trough: 5 to 10 mcg/ml

VIII. Pharmacokinetics

  1. Hepatic conjugation with glucuronide
  2. Renal excretion

IX. Drug Interactions

  1. Aminoglycosides
    1. Chloramphenicol interferes with Aminoglycoside transfer into Bacterial cells
  2. Drugs that decrease Chloramphenicol levels
    1. Barbiturates
    2. Rifampin
  3. Drug levels that are increased by Chloramphenicol
    1. Barbiturates
    2. Phenytoin
    3. Warfarin (INR)

X. Resources

XI. References

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Chloramphenicol (C0008168)

Definition (NCI) A semisynthetic, broad-spectrum antibiotic derived from Streptomyces venequelae with primarily bacteriostatic activity. Chloramphenicol diffuses through the bacterial cell wall and reversibly binds to the bacterial 50S ribosomal subunit. The binding interferes with peptidyl transferase activity, thereby prevents transfer of amino acids to the growing peptide chains and blocks peptide bond formation. As a result bacterial protein synthesis is blocked and impede bacterial cell proliferation.
Definition (MSH) An antibiotic first isolated from cultures of Streptomyces venequelae in 1947 but now produced synthetically. It has a relatively simple structure and was the first broad-spectrum antibiotic to be discovered. It acts by interfering with bacterial protein synthesis and is mainly bacteriostatic. (From Martindale, The Extra Pharmacopoeia, 29th ed, p106)
Definition (CSP) antibiotic first isolated from cultures of Streptomyces venequelae but now produced synthetically; has a relatively simple structure and was the first broad-spectrum antibiotic to be discovered; it acts by interfering with bacterial protein synthesis and is mainly bacteriostatic.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002701
SnomedCT 105907002, 330285002, 324291001, 330915003, 332767001, 273949002, 372777009, 57191001
LNC LP15321-0, MTHU004842
English Chloramphenicol, Cloranfenicol, Kloramfenikol, Acetamide, 2,2-dichloro-N-(2-hydroxy-1-(hydroxymethyl)-2-(4-nitrophenyl)ethyl)-, (R-(R*,R*))-, Chloramphenicol [ear], Chloramphenicol [eye], Chloramphenicol [skin], Chloramphenicol [systemic], [R-(R*,R*)]-2,2-Dichloro-N-[2-hydroxy-1-(hydroxymethyl)-2-(4-nitrophenyl)ethyl]acetamide, chloramphenicol, Chloramphenicol (class of antibiotic, substance), chloramphenicol (medication), Chloramphenicol Ophthalmic, chloramphenicol ophthalmic, chloramphenicol otic, Chloramphenicol [Chemical/Ingredient], kloramfenikol, chloramphenicol eye, chloramphenicols, cloranfenicol, CHLORAMPHENICOL, Chloramphenicol [ear] (product), Chloramphenicol [eye] (product), Chloramphenicol [skin] (product), Chloramphenicol [systemic] (product), Chloramphenicol product, Chloramphenicol (class of antibiotic), Chloramphenicol (class of antibiotic, substance) (substance), Chloramphenicol (product), Chloramphenicol (substance), Chloramphenicol, NOS, Chloramphenicol [dup] (substance), Chloramphenicol [ear] (substance), Chloramphenicol [eye] (substance), Chloramphenicol [skin] (substance), Chloramphenicol [systemic] (substance)
Spanish cloranfenicol (clase de antibiótico) (clase de antibiótico, sustancia), Cloramfenicol, cloranfenicol (uso oftálmico) (producto), cloranfenicol [uso sistémico] (producto), cloranfenicol (uso ótico), cloranfenicol (uso oftálmico), cloranfenicol (uso dermatológico) (producto), cloranfenicol [dup] (sustancia), cloranfenicol [uso sistémico], cloranfenicol (uso ótico) (producto), cloranfenicol (uso dermatológico), cloranfenicol (clase de antibiótico) (clase de antibiótico, sustancia) (sustancia), cloranfenicol (clase de antibiótico), cloranfenicol (oftálmico) (producto), cloranfenicol (oftálmico), cloranfenicol (oído) (producto), cloranfenicol (oído), cloranfenicol (piel) (producto), cloranfenicol (piel), cloranfenicol (producto), cloranfenicol (sustancia), cloranfenicol [sistémico] (producto), cloranfenicol [sistémico], cloranfenicol, Cloranfenicol
Swedish Kloramfenikol
Czech chloramfenikol
Finnish Kloramfenikoli
Russian KLORAMFENIKOL, LEVOMITSETIN, GLIUKOKHLORAL, KHLORAMFENIKOL, KHLORANFENIKOL, ГЛЮКОХЛОРАЛ, КЛОРАМФЕНИКОЛ, ЛЕВОМИЦЕТИН, ХЛОРАМФЕНИКОЛ, ХЛОРАНФЕНИКОЛ
Japanese レボマイセチン, ハイセチン, クロロマイセチン, クロランフェニコール, クロマイ, クロラムフェニコール
Croatian KLORAMFENIKOL
Portuguese Cloramfenicol, Cloranfenicol
Polish Chloramfenikol, Chloromycetyna
French Chloramphénicol
German Chloramphenicol, Chloranfenicol, Kloramfenikol
Italian Cloramfenicolo

Ontology: Gray syndrome from chloramphenicol administration in newborn (C0270276)

Definition (NCI) A disorder observed in a newborn who was exposed to chloramphenicol. Manifestations include hypotension, cyanosis, cardiovascular collapse and/or death.(NICHD)
Concepts Disease or Syndrome (T047)
ICD10 P93.0
SnomedCT 7690000
English GRAY BABY SYNDROME, GRAY SYNDROME NEONATAL, GREY SYNDROME NEONATAL, Chloramphen toxicity newborn, Gray syndrome of newborn, Gray syndrome neonatal, Grey syndrome neonatal, Grey syndrome, Grey syndrome from chloramphenicol administration in newborn, grey baby syndrome, grey syndrome, gray baby syndrome, gray baby syndrome (diagnosis), Gray Syndrome, Gray Baby Syndrome, Grey Syndrome, Gray syndrome from chloramphenicol administration in newborn, Chloramphenicol toxicity in newborn, Gray baby syndrome, Gray syndrome, Grey baby syndrome, Grey syndrome of newborn, Gray syndrome from chloramphenicol administration in newborn (disorder), gray syndrome (newborn), gray syndrome, gray; syndrome, syndrome; gray
Italian Sindrome grigia neonatale, Sindrome del bambino grigio, Sindrome grigia
Dutch gray-baby syndrome, grey-baby syndrome, gray-baby syndrome, neonataal, grey syndrome, grauw; syndroom, syndroom; grauw, grey syndrome, neonataal
French Syndrome gris du nouveau-né, SYNDROME DE GRAY (NOUVEAU-NE), SYNDROME GRIS DU NOURRISSON, Syndrome du bébé gris, Syndrome gris néonatal, Syndrome gris
German Grey-Syndrom, Gray-Baby-Syndrom, Gray-Syndrom beim Neugeborenen, Grey- Baby-Syndrom, GRAY SYNDROM NEUGEBORENES, GRAY SYNDROM SAEUGLING, Grey-Syndrom neonatal
Portuguese Sindrome cinzenta, Síndrome de bebé cinzento, Síndrome cinzenta neonatal, SINDROME DE GREY NEO-NATAL, SINDROME DO LACTENTE CINZENTO, Síndrome cinzento neonatal
Spanish Síndrome gris, SINDROME GRIS DEL RECIEN NACIDO, síndrome del bebé gris, síndrome gris del recién nacido, síndrome gris, Síndrome gris del recién nacido, síndrome gris por administración de cloranfenicol en el recién nacido (trastorno), síndrome gris por administración de cloranfenicol en el recién nacido
Japanese 新生児灰白症候群, 灰白症候群, グレイベビー症候群, シンセイジカイハクショウコウグン, グレイベビーショウコウグン, カイハクショウコウグン
Czech Syndrom šedého dítěte, Syndrom šedého novorozence
Hungarian Szürke csecsemő tünetegyüttes, Szürke csecsemő syndroma, Szürke újszülött syndroma, Szürke újszülöttkori syndroma, Szürke syndroma