What is the use of Chloramphenicol (antibiotic)?

From the Guidelines

Chloramphenicol should not be used as a first-line treatment for tickborne rickettsial diseases due to its association with higher risk of death and adverse hematologic effects, as well as its limited availability and lack of efficacy against certain diseases such as ehrlichiosis and anaplasmosis 1.

Key Points to Consider

• Chloramphenicol is associated with a higher risk of death compared to tetracyclines, such as doxycycline, in the treatment of Rocky Mountain spotted fever (RMSF) 1.
• The drug has adverse hematologic effects, including bone marrow suppression, which can lead to aplastic anemia, and requires regular blood monitoring 1.
• Chloramphenicol is not effective against ehrlichiosis and anaplasmosis, and its use may lead to delayed diagnosis and treatment of these diseases 1.
• The drug is no longer available in oral form in the United States, and its intravenous form is not readily available at all institutions 1.

Alternative Treatment Options

• Tetracyclines, such as doxycycline, are the recommended treatment for tickborne rickettsial diseases, including RMSF, ehrlichiosis, and anaplasmosis 1.
• Rifampin may be considered as an alternative treatment for mild anaplasmosis in pregnant women or patients with a documented allergy to tetracyclines, but its use should be approached with caution and only after ruling out RMSF 1.

Important Considerations

• The use of chloramphenicol should be avoided in pregnant women, newborns, and patients with liver or kidney dysfunction unless absolutely necessary 1.
• Regular blood monitoring is essential during treatment with chloramphenicol to detect early signs of bone marrow toxicity 1.
• The drug can be administered orally or intravenously, with good tissue penetration, including the central nervous system, making it valuable for treating meningitis, but its use should be limited to specific cases where benefits outweigh the risks 1.

From the FDA Drug Label

DESCRIPTION: Chloramphenicol is an antibiotic that is clinically useful for, and should be reserved for, serious infections caused by organisms susceptible to its antimicrobial effects when less potentially hazardous therapeutic agents are ineffective or contraindicated

WARNING Serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia and granulocytopenia) are known to occur after the administration of chloramphenicol. CONTRAINDICATIONS: Chloramphenicol is contraindicated in individuals with a history of previous hypersensitivity and/or toxic reaction to it.

Key Points:

• Chloramphenicol is used for serious infections when other treatments are ineffective or contraindicated.
• It can cause serious and fatal blood dyscrasias, such as aplastic anemia.
• The drug is contraindicated in individuals with a history of hypersensitivity or toxic reaction to it.
• It should not be used for trivial infections or as a prophylactic agent.

The answer to the question about Chloramphenicol is that it is an antibiotic with potentially serious side effects, and its use should be reserved for serious infections when other treatments are not effective 2, 2, 2.

From the Research

Properties and Clinical Use of Chloramphenicol

• Chloramphenicol was introduced into medical practice in 1949 and inhibits bacterial ribosomal and mammalian mitochondrial protein synthesis at therapeutic concentrations 3.
• It is most bioavailable after oral administration and has a remarkable ability to diffuse into body fluids and tissues, but there are wide interindividual variations in its metabolism and elimination, particularly in newborns 3.
• Chloramphenicol is indicated for various infections, including invasive ampicillin-resistant H. influenzae infections, pneumococcal, meningococcal or H. influenzae meningitis, and brain abscesses 3, 4.

Toxicity and Adverse Reactions

• Potential toxicity limits the use of chloramphenicol, with adverse reactions including bone marrow suppression, the "gray baby syndrome", and aplastic anemia 3, 4.
• The incidence of aplastic anemia after chloramphenicol treatment is estimated to be 1 in 24,500-40,800 courses of treatment 4.
• Reversible, dose-related bone marrow suppression is the most common toxicity, identified by serial monitoring of reticulocyte and complete blood cell counts 4.

Current Clinical Practice and Efficacy

• Chloramphenicol is used in approximately 37% of hospitals in the Czech Republic, with a frequency of up to 10 patients treated per year 5.
• The most common indications for chloramphenicol use are brain abscesses, purulent meningitis, and polymicrobial infections with anaerobes 5.
• A systematic review and meta-analysis found that chloramphenicol is not recommended as a first-line treatment for respiratory tract infections, meningitis, or enteric fever due to its higher mortality rates compared to alternative antibiotics 6.
• However, chloramphenicol is considered safe for short antibiotic courses and may be a suitable alternative when other options are not available 6.