chloramphenicol; levomycetin; chloranfenicol; kloramfenikol (Chloromycetin, Chloroptic)
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Introduction
Topical agent: Tradename: Chloromycetin. Ophthalmic agent: Tradename: Chloroptic.
Indications
- systemic agent
- meningitis when other agents are contraindicated
- serious infections when other agents are inadequate or contraindicated
- antibiotic prophylaxis during mastoidectomy
- ophthalmic agent
- treatment of eye infection including:
- keratitis, keratoconjunctivitis
- blepharoconjunctivitis & eyelid diseases
- otic agent: otitis externa
Contraindications
Caution:
- patients with renal or hepatic impairment
- neonates
Dosage
- systemic
- meningitis: 75-100 mg/kg/day divided every 6 hours
- other infections
- ophthalmic -0.5% & 1% ointment every 3-4 hours or BID-QID
Injection: sodium succinate 100 mg/mL Suspension, oral, as palmitate: 150 mg/5 mL (60 mL)
Monitor
Therapeutic drug monitoring: Therapeutic range:
Antimicrobial activity
- Streptococcus
- Staphylococcus aureus (MSSA) (+/-)
- Neisseria gonorrhoeae
- Neisseria meningitidis[7]
- Moraxella catarrhalis
- Haemophilus influenzae
- Aeromonas
- Escherichia coli
- Klebsiella species (+/-)
- Proteus vulgaris (+/-)
- Pseudomonas cepacia
- Xanthomonas maltophilia
- Yersinia enterocolitica
- Francisella tularensis
- Brucella species
- Haemophilus ducreyi
- Vibrio vulnificus
- Actinomyces
- Bacteroides fragilis
- Bacteroides melaninogenicus
- Clostridium difficile (+/-)
- Clostridium species
Adverse effects
- uncommon (< 1%)
- the most common offending agent in drug-induced pancytopenia
- optic neuritis, peripheral neuropathy, nightmares, headache, rash, diarrhea, stomatitis, enterocolitis, gray baby syndrome, bone marrow suppression, aplastic anemia, nausea/vomiting
- ocular irritation with ophthalmic agent
Drug interactions
- chloramphenicol inhibits metabolism of:
- phenobarbital & rifampin may decrease serum levels of chloramphenicol
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Laboratory
- specimen:
- serum, plasma (heparin, EDTA)
- collect at trough concentration
- centrifuge & separate from cells if not assayed immediately
- methods: HPLC, GLC, MB, color, EIA
- interferences: colorimetric assays may not distinguish between biologically active & inactive forms of chloramphenicol
Mechanism of action
- inhibits protein synthesis in bacteria & to a lesser extent in eukaryotic cells
- acts primarily by binding reversibly to the 50S ribosomal subunit
- can also inhibit mitochondrial protein synthesis in mammalian cells
- mammalian erythropoietic cells appear to be particularly sensitive to chloramphenicol
More general terms
More specific terms
References
- ↑ The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill pg 1125
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ 7.0 7.1 7.2 Deprecated Reference