chloramphenicol (redirected from Chloramphenicol palmitate)

chloramphenicol /chlor·am·phen·i·col/ (klor″am-fen´ĭ-kol) a broad-spectrum antibiotic effective against rickettsiae, gram-positive and gram-negative bacteria, and certain spirochetes; used also as the palmitate ester and as the sodium succinate derivative.

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chlor·am·phen·i·col (klôrm-fn-kôl, -kl)

n.

A broad-spectrum antibiotic derived from the soil bacterium Streptomyces venezuelae or produced synthetically.

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chloramphenicol

[-amfē′nikol]

an antibacterial and anti-rickettsial.

indications It is used for the treatment of serious infections when the microorganism is resistant to less toxic antibiotics and also when its ability to penetrate to the site of the infection is superior to less toxic alternative antibiotics.

contraindications It is used only when safer drugs are contraindicated; pregnancy, lactation, or known hypersensitivity to this drug also prohibits its use.

adverse effects Among the more serious adverse reactions are bone marrow depression, aplastic anemia, and gray syndrome (characterized by circulatory collapse, cyanosis, acidosis, abdominal distention, coma, and death).

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Chloramphenicol,

n a broad-spectrum antibacterial and antirickettsial agent that should be reserved for serious infections in which other agents are ineffective.

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chloramphenicol

a broad-spectrum antibiotic with specific therapeutic activity against gram-positive and gram-negative bacteria, rickettsiae, chlamydia and anaplasmae. Side-effects in animals are uncommon, but its use in food-producing animals is discouraged or prohibited because of the danger of residues to humans. The palmitate preparation is a suspension administered orally and chloramphenicol sodium succinate is water soluble for parenteral use.

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chloramphenicol 

A broad-spectrum antibiotic effective against a wide variety of Gram-negative and Gram-positive bacteria (but not Pseudomonas aeruginosa). It is commonly used in solution 0.5% or ointment 1% to treat bacterial conjunctivitis or blepharitis.

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chloramphenicol Warning - Hazardous drug!

Chloromycetin Ophthalmic, Novochlorocap (CA), Pentamycetin (CA)

Pharmacologic class: Dichloroacetic acid derivative

Therapeutic class: Anti-infective

Pregnancy risk category NR

FDA Boxed Warning

• Bone marrow hypoplasia (including aplastic anemia and death) has been reported after topical use. Don't give drug when less potentially dangerous agents could be effective.

Action

Exerts bacteriostatic activity by binding with 50S subunit of ribosome and inhibiting protein synthesis

Availability

Injection: 1-g vial

Ointment (ophthalmic): 10 mg/g

Powder for solution (ophthalmic): 25 mg/vial

Solution (ophthalmic): 5 mg/ml

⊘Indications and dosages

➣ Serious infections when less potentially dangerous drugs are ineffective or contraindicated

Adults: 50 to 100 mg/kg/day I.V. in divided doses q 6 hours, to a maximum dosage of 4 g/day

Children: 50 to 75 mg/kg/day I.V. in divided doses q 6 hours

➣ Bacteremia or meningitis

Children: 50 to 100 mg/kg/day I.V. in divided doses q 6 hours

➣ Ocular infections

Adults and children: Instill two drops of ophthalmic solution in each eye q.i.d. As supplement to solution, apply small amount of ophthalmic ointment to conjunctival sac at bedtime. (Solution and ointment may be used together or alone.)

Dosage adjustment

• Hepatic or renal impairment

Off-label uses

• Unspecified acne

Contraindications

• Hypersensitivity to drug
• Severe renal or hepatic impairment
• Prophylaxis for bacterial infections
• Acute porphyria

Precautions

Use cautiously in:
• hepatic disease, renal disease, bone marrow depression
• pregnant or breastfeeding patients
• infants and children.

Administration

• Dilute parenteral dose with aqueous solution (for example, water for injection or dextrose 5% in water injection) to at least 100 mg/ml.
• Give parenteral form by I.V. injection over at least 1 minute. For intermittent infusion, drug may be diluted further in 50 to 100 ml of dextrose 5% in water and given over 10 to 30 minutes.
• Don't give drug I.M.
☞ Know that drug may cause serious reactions (because of its narrow therapeutic window) and should be used only when safer anti-infectives are ineffective or contraindicated.

Route	Onset	Peak	Duration
I.V.	Immediate	1-2 hr	8 hr
Ophthalmic	Unknown	Unknown	Unknown

Adverse reactions

CNS: confusion, delirium, depression, headache, peripheral neuropathy

EENT: optic neuritis, vision loss

GI: nausea, vomiting, diarrhea, abdominal pain, glossitis, colitis, pruritus ani, dry mouth

Hematologic: reticulocytopenia, aplastic anemia, bone marrow depression, granulocytopenia, hypoplastic anemia, leukopenia, thrombocytopenia

Skin: rash, itching, urticaria, contact dermatitis, angioedema

Other: fever, anaphylaxis, gray syndrome in neonates

Interactions

Drug-drug. Aminoglycosides, penicillins: decreased activity of these drugs

Barbiturates: increased barbiturate level, decreased chloramphenicol blood level

Hepatic enzyme inducers: decreased chloramphenicol blood level

Hydantoins: increased hydantoin blood level

Iron salts: increased iron level

Myelosuppressants, drugs that cause blood dyscrasias: increased bone marrow depression

Vitamin B₁₂: antagonism of hematopoietic response

Warfarin: enhanced warfarin action

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, hemoglobin, platelets, red blood cells, white blood cells: altered values

Patient monitoring

☞ Monitor patient for signs and symptoms of aplastic anemia, which may occur weeks or months after therapy ends.
• Monitor CBC count closely.
• Assess hepatic enzyme levels in patients with hepatic disease.
• Monitor creatinine levels in patients with renal insufficiency or failure.

Patient teaching

☞ Instruct patient to report bleeding or bruising, even if therapy ended several weeks or months earlier.
• Tell patient to report rash or itching.
• Caution patient to avoid pregnancy during therapy. If she's using hormonal contraceptives, advise her to use additional birth control method (drug may make hormonal contraceptives ineffective).
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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chloramphenicol

Infectious disease A broad-spectrum antibiotic effective against gram-positive cocci–eg Staphylococcus aureus and gram-negative coccobacilli–eg Brucella abortus Complications Aplastic anemia