Chloramphenicol: Broad-Spectrum Antibiotic Guide for Meningitis and Severe Infections
Chloramphenicol treats serious infections like meningitis. Learn the mechanism, spectrum, uses, side effects, and drug interactions.
Introduction
Chloramphenicol is a broad-spectrum, bacteriostatic antibiotic that inhibits bacterial protein synthesis. Doctors reserve it for serious infections due to its potential for severe toxicity.
Medications in the Class
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Mechanism of Action
Chloramphenicol attaches to the 50S ribosomal subunit. This stops peptidyl transferase and blocks protein synthesis. It is bacteriostatic but can be bactericidal against some organisms like Haemophilus influenzae.
Spectrum of Activity
Gram-positive bacteria: Streptococcus pneumoniae, Staphylococcus aureus (including some MRSA)
Gram-negative bacteria: H. influenzae, Neisseria meningitidis, Salmonella spp.
Anaerobes: Bacteroides fragilis
Other pathogens: Rickettsia, Chlamydia
Not effective against: Pseudomonas, Proteus
Indications (When Used)
Meningitis caused by H. influenzae, N. meningitidis
Typhoid fever and Salmonella infections
Rickettsial infections (Rocky Mountain spotted fever)
Severe infections where other antibiotics are contraindicated
Contraindications (When Not to Use)
Known hypersensitivity to chloramphenicol
Bone marrow suppression or pre-existing anemia
Neonates (<2 weeks) are due to the risk of gray baby syndrome.
Side Effects
Bone marrow suppression: aplastic anemia, a rare condition that can lead to death.
Gray baby syndrome in neonates
Gastrointestinal upset
Rash, fever
Rare: optic neuritis, peripheral neuropathy
Drug Interactions
Warfarin: enhanced anticoagulant effect
Chloramphenicol inhibits CYP450, increasing levels of phenytoin, tolbutamide, and others.
Other myelosuppressive drugs: additive toxicity.
Antidote
No specific antidote; supportive care for toxicity. Doctors may need to perform blood transfusions for severe aplastic anemia.
Monitoring of Potential Complications
Complete blood count during therapy.
Liver function tests
Monitor neonates for signs of toxicity with close attention.
Watch for signs of superinfection.
Chloramphenicol is a potent broad-spectrum antibiotic reserved for life-threatening infections. Careful monitoring is crucial due to the risk of bone marrow toxicity and gray baby syndrome.