Chloramphenicol adverse reaction

Serious and sometimes fatal blood dyscrasias (patiiologic condition of blood disorder of cellular elements of blood) are die chief adverse reaction seen witii the adiniiiistration of chloramphenicol, hi addition to blood dyscrasias superinfection, hypersensitivity reactions, nausea, vomiting, and headache may be seen. It is recommended that patients receiving oral chloramphenicol be hospitalized so that patient observation and frequent blood studies can be performed during treatment witii this drug. 

Educating the Patient and Family Anytime a drug is prescribed for a patient, the nurse is responsible to ensure that the patient has a thorough understanding of the drug, the treatment regimen, and the potential adverse reactions. Not all of the miscellaneous anti-infectives are prescribed for use within the clinical setting. Chloramphenicol, metronidazole, and... 

In some drug reactions, several of these hypersensitivity responses may present simultaneously. Some adverse reactions to drugs may be mistakenly classified as allergic or immune when they are actually genetic deficiency states or are idiosyncratic and not mediated by immune mechanisms (eg, hemolysis due to primaquine in glucose-6-phosphate dehydrogenase deficiency, or aplastic anemia caused by chloramphenicol). 

Blood dyscrasias, mostly dose independent, are among the most important allergic-type adverse reactions to drugs. Aplastic anemia is a serious but rare (presumably) idiosyncratic reaction. It has been reported in association with chloramphenicol, quinacrine, phenylbutazone, mephenytoin, gold compounds, and potassium chlorate. Hemolytic anemia, thrombocytopenia, and agranulocytosis may result from an unusual, acquired sensitivity to a variety of widely used drugs including aminopyrine, phenylbutazone, phenothiazines, propylthiouracil, diphenylhydantoin, penicillins, chloramphenicol, sulfisoxazole, and tolbutamide. 

Althongh seldom nsed in the United States, chloramphenicol has a broad spectrnm of activity against S.pneumoniae and many gram-negative organisms. Becanse of the potential for adverse reactions, other readily available... 

Adverse effects might be produced when chloramphenicol is administered with other medications. Here are potential adverse reactions ... 

Chloramphenicol is not adequately detoxified and excreted by the fetus or the premature infant. Administration of this antibiotic to the mother shortly before parturition may produce gray coloration of the infant s skin with associated muscle hypotonia and circulatory collapse, known as the gray baby syndrome [9], (This adverse reaction is more often noted in premature infants.)... 

There is mounting evidence for a higher incidence of adverse reactions in children compared with adults. Frequently quoted is gray baby syndrome in newborns treated with chloramphenicol due to poor... 

UK manufacturer lists carbamazepine (see also Clozapine + Anti epileptics , p.744), chloramphenicol, cytotoxics, penicillamine, pyrazolone analgesics (e.g. phenylbutazone), sulphonamides (e.g. co-trimoxazole) and, because they cannot be stopped if an adverse reaction occurs, they advise against the use of depot antipsychotics. There are several cases that confirm the clinical significance of these predicted interactions. 

The severity of an adverse reaction is usually much more important than its frequency. For an effective anti-infective drug (e.g. an aminopenicillin preparation), high frequency of an exanthema (in 5%-10% of patients or 5-10,000 of 100,000 treatments) is acceptable however, for a life-threatening reaction such as pancytopenia (in the case of chloramphenicol) observed in only about 2 of 100,000 patients treated (very low frequency), other drugs are preferred except in rare and selected indications. 

The answer is c. (Hardman, pp 1134-1135.) Hematologic toxicity is by far the most important adverse effect of chloramphenicol The toxicity consists of two types (1) bone marrow depression (common) and (2) aplastic anemia (rare) Chloramphenicol can produce a potentially fatal toxic reaction, the gray baby syndrome, caused by diminished ability of neonates to conjugate chloramphenicol with resultant high serum concentrations. Tetracyclines produce staining of the teeth and phototoxicity... 

Holt D., D. Harvey, and R. Hurley (1993). Chloramphenicol toxicity. Adverse Drug Reactions and Toxicological Reviews 12 83-95. 

Adverse events are sometimes termed type A (usually pharmacologically predictable, relatively frequent, seldom fatal and usually identified during clinical trials) or type B (unpredictable idiosyncratic reactions which are usually infrequent but can be very serious or fatal) (Rawlins and Thompson, 1977 Venning, 1983). Postmarketing ADR monitoring usually identifies the more serious, type B reactions. The sample size needed in clinical trials to detect differences between an incidence rate of 1/10 000 and 2/10 000 is about 306 000 patients (e.g. for a placebo comparison of chloramphenicol-induced aplastic anemia, which occurs in 1/30 000 Lasagna, 1983). Clinical trials at this scale are simply impractical. 

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