Chloramphenicol



Chloramphenicol is a broad-spectrum bacteriostatic antibiotic, it has a bactericidal effect in high doses. It is an effective but relatively dangerous ATB. It is never used as a drug of first choice! In the 1970s, its use was severely limited because of its negative side effect, namely the possibility of inducing aplastic anemia.

Mechanism
It inhibits proteosynthesis, binds to the 50S subunit of the ribosome.

Spectrum of effect
Most aerobic G + and G− bacteria, G + and G− anaerobes are sensitive, including Bacteroides fragilis, Rikettsia , Chlamydia , mycloplasmas, Neisseria meningitidis and Salmonella.

Pharmacokinetics
It is very well absorbed, which is used in life-threatening conditions. It is applied mainly parenterally, with the possibility of oral administration. It has a small volume of distribution. It penetrates well into tissues, thanks to the small size of the molecule it also penetrates into the cerebrospinal fluid. It is metabolised by the liver and excreted by the kidneys. It affects the levels of many drugs (eg warfarin or phenytoin ).

Indications

 * Typhoid fever
 * Invasive haemophilus infection (serotype b) resistant to ampicillin
 * Severe anaerobic infections
 * Meningococcal or pneumococcal CNS infections
 * Anaerobic or mixed CNS infections ( abscess )

Contraindication
The absolute contraindication is the administration of chloramphenicol to immature infants due to reduced liver and kidney function (development of the so-called gray baby syndrome).

Side effects

 * Nausea and vomiting.
 * Bone marrow disorders - after a dose higher than 50 mg / kg and used for more than 1-2 weeks, there are regular disorders of erythrocyte maturation (vacuolated nucleated blood cells in the bone marrow), anemia and reticulocytopenia, which are reversible.
 * Aplastic anemia - probably in people with genetically determined predisposition, in 50% irreversible . The onset does not depend on the dose or time of administration.

Gray baby syndrome
Gray baby syndrome (gray according to skin color) ( Gray syndrome, Gray syndrome ) occurs in newborns (especially premature infants) after administration of chloramphenicol. The cause is an underdeveloped detoxifying glucuronidase system. The syndrome is characterized by hypotension, hypoperfusion of organs, develops into collapse and shock. Administration should be very careful with reduced doses if unavoidable.

related articles

 * Antibiotics
 * Antibiotic therapy in neonatal age
 * Antibiotic for the treatment of stapylococcal infection

Source

 * BENEŠ, Jiří. Study materials  [online]. [feeling. 2009]. < http://jirben.wz.cz >.

Použitá literatura

 * LINCOVÁ, Dagmar and Hassan FARGHALI, et al. Basic and applied pharmacology. 2nd edition. Prague: Galén, 2007. pp. 481.  ISBN 978-80-7262-373-0.


 * HAVLIK, Jiri, et al. Infectious diseases. 2nd edition. Prague: Avicenum, 1990. 393 pp.  ISBN 80-201-0062-8.


 * LOBOVSKÁ, Alena. Infectious diseases. 1st edition. Prague: Karolinum, 2001. 263 pp.  ISBN 80-246-0116-8.


 * MARTÍNKOVÁ, Jiřina, Stanislav MIČUDA and Jolana CERMANOVÁ, et al. Selected chapters from clinical pharmacology for bachelor study  [online]. © 2005. [feeling. 2010-08-14]. < https://www.lfhk.cuni.cz/farmakol/predn/prednbak.htm/ >.