Chloramphenicol treatment

In a small fraction of patients who survive the chronic type of bone marrow damage, myeloblastic leukemia develops (41,42). In most instances this complication has appeared within a few months of the diagnosis of aplasia and was considered to be a sequel of chloramphenicol treatment. Sometimes the delay was shorter. The majority were either children or adults aged 50-70 years. 

Inhibition of tacrolimus clearance has been observed in an adolescent renal transplant recipient who was treated with standard doses of chloramphenicol for vancomycin-resistant enterococci. Toxic concentrations of tacrolimus were observed on the second day of chloramphenicol treatment, requiring an 83% reduction in the dose of tacrolimus (81). 

Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J. A population-based case-control teratologic study of oral chloramphenicol treatment during pregnancy. Eur J Epidemiol 2000 16(4) 323-7. 

So far only four cases of an interaction between rifampicin and chloramphenicol appear to have been reported. However, the evidence is of good quality and in line with the way rifampicin interacts with other drugs, so this interaction should be taken seriously. There is a risk that serum chloramphenicol levels will become subtherapeutic. The authors of the second report point out that raising the chloramphenicol dosage may possibly expose the patient to a greater risk of bone marrow aplasia. They suggest delaying rifampicin prophylaxis in patients with invasive Haemophilus influenzae infections until the end of chloramphenicol treatment. 

Investigating 1,700 routine hospital blood bank sera, Watson and Joubert (1960) found 6 sera capable of agglutinating chloramphenicol-sensitized human red blood cells. None of the sera produced a positive Coombs test and 5 of 6 patients had no previous history of chloramphenicol treatment. The patient with the highest titer (1 128) had apparently never received any antibiotic therapy. It was suggested therefore, that sensitization had arisen by contact with an unrelated compound sharing a common determinant. 

Zhou X, Traxler RW (1992) Enhanced butanol production and reduced autolysin activity after chloramphenicol treatment of Clostridium acetobutylicum ATCC 824. Appl Microbiol Biotechnol 7 29 297... 

This is by far the most versatile route to the synthesis of ester-substituted aziridines, especially as the benzhydryl group can easily be cleaved by hydrogenolysis. Wulff has applied this methodology to a short asymmetric synthesis of the antibiotic (-)-chloramphenicol in four steps from p-nitrobenzaldehyde (Scheme 1.34) [61]. In this case it was found that treatment of the aziridine 111 with excess dichloroacetic acid gave the hydroxy acetamide directly, so no separate deprotection step was required. 

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... 

Erythromycin is considered the optimal drug for treatment of Campylobacter infections. The rate of resistance of Campylobacter to erythromycin remains low. Other advantages of this drug include ease of administration, low cost, lack of major toxicity, and narrow spectrum of activity.14 The recommended dosage for adults is 250 mg orally four times daily or 500 mg orally twice daily for 5 to 7 days. For very ill patients, treatment with gentamicin, imipenem, cefotaxime, or chloramphenicol is indicated, but susceptibility tests should be performed. 

Implications for treatment. It has recently been shown that tetracycline inhibits the development of filarial nematodes from L3 to L4 in vitro (Smith and Rajan, 2000, Experimental Parasitology 95, 265-270). However, chloramphenicol, erythromycin and ciprofloxacin failed to inhibit the... 

Chloramphenicol may be used in place of penicillin G. Several third-generation cephalosporins (e.g., cefotaxime, ceftizoxime, ceftriaxone, and cefuroxime) approved for the treatment of meningitis are acceptable alternatives to penicillin G (Table 36-5). Meropenem and fluoroquinolones are suitable alternatives for treatment ofpenidUin-nonsusceptible meningococci. 

Because human cases of glanders are rare, there is limited information shout antibiotic treatment of the organism in humans. Sulfadiazine has been found to be an effective in experimental animals and in humans SutfMderiente/fer is usually sensitive to tetracyclines, ciproflacacin, streptomycin, novobiocin, gentamicin, imipenem, ceftazidime, and the sulfonamides Resistance to chloramphenicol has been reported. 

Early treatment of pneumonic plague is essential. To reduce the chance of death, antibiotics must be given within 24 hours of first symptoms. Streptomycin, gentamicin, the tetracyclines, and chloramphenicol are all effective against pneumonic plague. 

Treatment — A number of antibiotics including tetracycline, streptomycin, gentamicin, chloramphenicol, and quinolone3 are available for treatment. 

Treatment — No vaccines are available. Melioidosis may be treated with tetracycline, chloramphenicol, trimethoprim-sulfamethoxazole, doxycycline, and ceftazidime.3... 

Antibacterial treatment is generally not required in cases of gastroenteritis. Typhoid fever is treated with ciprofloxacin (quinolone), cefotaxime (third generation cephalosporin) or chloramphenicol. Impetigo necessitates the systemic use of flucloxacillin or erythromycin. Topical fusidic acid or mupirocin may also be used. 

---