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Chloramphenicol (Chlornitromycin)

Description

Chloramphenicol is one of the world’s earliest natural antimicrobial preparations, called into existence in the middle of the past century. The greatest value of Chloramphenicol treatment consists in ability to treat meningitis, rickettsial diseases, salmonellosis and anaerobic infections.

Chloramphenicol has a bacteriostatic action, associated with impaired protein synthesis ribosomes. In high concentrations, the preparation has a bactericidal effect against pneumococci and meningococci; characterized by a wide spectrum of antimicrobial activity.

Among gram-positive cocci, pneumococcus is the most sensitive type to the drug, though many strains are penicillin-resistant. Enterococci are generally insensitive to the drug, while the most sensitive gram-negative cocci type is meningococcus.

Chloramphenicol is intended for oral administration; being a well absorbed preparation, the food does not affect the bioavailability. The maximum concentration in serum after ingestion is achieved within 1 – 3 hours if taken periorally (though, the preparation may be administered intravenously, ensuring maximum concentration within 1 – 1.5 hours).

The medication passes through the blood-brain barrier and the placenta (enters breast milk). The highest concentration is achieved in the brain tissue, bronchial secretions, pleural and synovial fluids, the lowest one – in the bile. The medication is metabolized in the liver. The half-life in adults equals 1.5-3.5 hours and up to 6.5 hours in children.

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Chloramphenicol: instructions for use

The drug is taken orally half an hour before meals. Adults are typically prescribed 0.25 - 0.5g every six hours. For the treatment of severe infections the preparation is appointed four times a day in a dosage of up to one gram. In this case it is necessary to monitor renal function as well as liver and red blood behavior cells carefully. Chloramphenicol dosage for children is calculated based on the child's age and body weight. The duration of therapy lasts 7-10 days on average. If necessary, the course may be extended to 14 days in case of good patient tolerability. In ophthalmology chloramphenicol eyedrops are used for instillation into the conjunctival sac of burying two drops of 3 to 5 times per day.

Chloramphenicol precautions

When using chloramphenicol a reversible blood cell count decrease is possible, which is oftentimes monitored with high doses (4 g or more per day) and long courses accompanied with high drug concentrations in the serum. Infants and patients with liver disease also fall into an increased risk group. Taking chloramphenicol pills during pregnancy must be avoided, which explained by the risk of possible toxic impact on the fetus. When an expectant or a newborn mother is on chloramphenicol course, the preparation is built in breast milk in high concentration; therefore, either the administration of the drug or lactation must be ceased.

Since a detoxifying function of the liver In newborns is not developed enough, it may contribute to the accumulation of toxic concentrations of chloramphenicol and can lead to the development of ‘gray syndrome’. The patients with abnormal liver function are not recommended to use. The application of chloramphenicol increases the frequency of microbial infections of the mouth, slows down the healing process and bleeding gums, which may also be a manifestation of myelotoxicity. Any dental intervention should be completed before the therapy starts.

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