Chloramphenicol (Injection, Intravenous, Oral)

Used to treat bacterial infections, Chloramphenicol can be taken orally, given via intravenous injection or administered via intravenous infusion.

Overview

As an antibiotic, Chloramphenicol is used to treat patients who have been diagnosed with a bacterial infection. In most cases, Chloramphenicol is only used to treat serious or life-threatening infections when it is prescribed orally, via intravenous injection or intravenous infusion.

Although Chloramphenicol is an effective antibiotic treatment for bacterial infections, it can have serious side-effects. Due to this, Chloramphenicol is only used when necessary and in instances when other, safer antibiotics are not appropriate or if they have failed to adequately treat the infection.

Chloramphenicol may be used to treat infections, such as, bacterial meningitis, cholera, typhoid, and sepsis. In addition to this, Chloramphenicol can be used to treat patients affected by plague and tularemia, as well as patients who have been exposed to anthrax.

When the medication takes effect, it interferes with bacteria cells present in the body. In doing so, Chloramphenicol prevents the infection from spreading further and kills the bacteria which are present. As this happens, patients should notice a reduction in symptoms and, once all bacteria has been eradicated, the infection will be fully resolved.

As treatment with Chloramphenicol is reserved for the most serious of bacterial infections, it should not be prescribed to patients who are suffering with mild or moderate infections, unless other medications have already been tried. Similarly, antibiotic treatment will not be effective in treating fungal and/or viral infections and should not be given to patients with these types of infections.

Most people who are receiving treatment with Chloramphenicol will be inpatients in a clinical setting. If administered intravenously, for example, the medication can only be given by a qualified medical professional and will only be delivered in a hospital or clinical setting.

Although Chloramphenicol oral treatment and injections can, theoretically, be prescribed for home use, patients will typically receive these medications whilst in a hospital or medical setting. As Chloramphenicol is only used to treat serious or resistant infections, the patient's condition normally required in-patient care, particularly before Chloramphenicol has begun to take effect.

If patients require treatment with Chloramphenicol, the potential complications should be clearly discussed. If patients are not well enough to converse with the medical team, the risks of using Chloramphenicol should be discussed with the patient's representative and/or next of kin.

Although Chloramphenicol is not normally a first choice antibiotic, it can provide life-saving treatment when other medications have failed to work or if patients cannot tolerate alternative treatments.

Conditions Treated

  • Bacterial Infections

Type of Medicine

  • Antibiotic

Side Effects

When receiving antibiotic treatment, it's not unusual for patients to suffer some side-effects. Generally, these are not severe and fully resolve once the patient has finished the course of treatment. When receiving treatment with Chloramphenicol, patients may experience nausea and/or diarrhea, for example.

There are some side-effects which require medical intervention, however. If patients experience the following side-effects when taking Chloramphenicol or when receiving Chloramphenicol via intravenous injection or infusion, they should inform their physician immediately:

  • Sore throat and fever
  • Skin rash, fever, or difficulty in breathing
  • Eye pain, blurred vision, or loss of vision
  • Unusual bleeding or bruising
  • Pale skin
  • Unusual tiredness or weakness (the above side effects may also occur up to weeks or months after you stop taking this medicine)
  • Confusion, delirium, or headache
  • Numbness, tingling, burning pain, or weakness in the hands or feet

In very rare cases, side-effects may warrant urgent medical treatment and they can be indicative of an adverse reaction to the medication. If the patients exhibit the following side-effects, treatment with Chloramphenicol should be stopped or suspended and medics should take immediate action:

  • Bloated stomach
  • Unresponsiveness
  • Drowsiness
  • Low body temperature
  • Gray skin color
  • Uneven breathing

Dosage

As Chloramphenicol is used to treat a variety of different bacterial infections, the dosage of the medication can vary significantly. When determining how much Chloramphenicol to administer, physicians will take the type of infection into account, as well as the severity of the patient's condition and their medical history. As Chloramphenicol can be administered alongside other antibiotics, this can also affect the dose of medication given.

When Chloramphenicol is given, the dose is normally dependent on the patient's weight. If prescribed in oral form, as an injection or an intravenous infusion, patients are normally given 12.5mg of Chloramphenicol per kg of body weight every 6 hours. Children over the age of 2 weeks are typically given 12.5mg per kg of body weight every 6 hours or 25mg per kg of body weight every 12 hours. If infants under the age of 2 weeks are treated with Chloramphenicol, the usual dose is 6.25mg per kg of body weight every 6 hours.

If the infection has proved resistant to other treatments and if the severity warrants it, Chloramphenicol can be given intravenously at a dose of 50mg per kg of body weight on a daily basis. In exceptional cases, physicians may deem it appropriate to give Chloramphenicol at a rate of 100mg per kg of body weight per day. It is vital, however, that physicians reduce the dose of Chloramphenicol as soon as it is possible to do so.

If patients are prescribed Chloramphenicol to be taken orally, as a capsule or liquid, they are normally advised to take the medication on an empty stomach, with an 8oz glass of water. This means that patients should take their dose of Chloramphenicol at least 1 hour before eating or at least 2 hours after a meal.

If patients are given Chloramphenicol in liquid form, the dose should be measured using a medical syringe, cup or medicine spoon. This ensures that the patient receives the correct amount of the medication. As the majority of patients receiving Chloramphenicol are treated in hospital, their doses will be managed by nurses and other medical staff.

Potential Drug Interactions

All medicines, vitamins and supplements have the potential to interact with one another. Due to this, it is inappropriate to use some medications in conjunction with others. If patients have recently taken or received the following medications, physicians may be unable to treat them with Chloramphenicol:

  • Citalopram
  • Voriconzole
  • Cholera vaccine, live

The following medications may result in interactions occurring if patients are also given Chloramphenicol:

  • Ceftazidime
  • Warfarin
  • Chlorpropamide
  • Aztreonam
  • Cyclosporine
  • Cyanocobalamin (Vitamin B12)
  • Dicumarol
  • Fosphenytoin
  • Folic Acid
  • Phenytoin
  • Iron supplements
  • Rifampin
  • Chlorpropamide
  • Rifapentine
  • Phenobarbital
  • Tacrolimus
  • Phenytoin
  • Tetanus Toxoid
  • Tolbutamide

Although the medicines listed above may interact with Chloramphenicol, this does not necessarily mean that patients cannot tolerate both medications. Doctors may alter the dosage of medications so that interactions are lessened or treat side-effects which may occur due to the interaction.

As prescription medications can interact with over-the-counter medicines, vitamins and supplements, patients should inform their physician if they are taking any other substances before they are given Chloramphenicol.

Warnings

As Chloramphenicol can cause blood problems to occur in some patients, individuals with a history of anemia may not be suitable for treatment with this medication.

If patients have a history of liver disease, they may experience increased side-effects when receiving treatment with Chloramphenicol. Due to this, physicians may alter their treatment regime or avoid using Chloramphenicol altogether.

Chloramphenicol can affect cells within the body and may cause certain blood cells to decrease. Some patients who experienced this developed leukemia at a later date. Patients should be made aware of this prior to treatment commencing. Once receiving Chloramphenicol medication, patients should be regularly monitored. Doctors should check the patient's level of blood cells on a regular basis so that a decrease is noted immediately. Whilst these tests can indicate a drop in the amount of blood cells in the patient's body, they do not always indicate that a decrease has taken place and cannot, therefore, confirm that the patient isn't at risk of developing leukemia in the future.

Prior to treatment, patients should tell their physician if they have received treatment with Chloramphenicol before and, if so, whether they suffered any side-effects.

If patients are due to undergo any medical procedures, including dental treatment, after receiving treatment with Chloramphenicol, they should ensure that their doctor and/or dentist are aware that they have been given this medication.

Newborns and infants can be particularly susceptible to side-effects when treated with Chloramphenicol. In some cases, infants up to the age of 2 years may develop 'gray syndrome' after being treated with Chloramphenicol. In addition to this, infants may develop the syndrome if their mother was treated with Chloramphenicol during pregnancy or labor. If gray syndrome occurs, it normally develops after 3-4 days of treatment and symptoms may include:

  • Blue lips and skin due to a lack of oxygen in the blood
  • Stomach bloating
  • Low blood pressure
  • Vomiting
  • Difficulty breathing

In some cases, 'gray syndrome' can be fatal. Due to the severity of the syndrome, treatment should be stopped as soon as the patient exhibits these symptoms. If treatment is stopped quickly enough, the symptoms may subside and the patient may go on to fully recover.

Although there have been limited studies on the effects of Chloramphenicol when breastfeeding, it is not normally recommended that mothers breastfeed when receiving this type of treatment. Patients should discuss this with their physician before breastfeeding if they are receiving treatment with Chloramphenicol or if they have recently been treated with this medication.

Chloramphenicol can cause false or abnormal results in urine sugar tests. This can raise particular difficulties when treating patients with diabetes. The accuracy of sugar tests should be confirmed before changes are made to the patient's diabetes treatment if they have recently been given Chloramphenicol.

As well as being monitored whilst being treated with Chloramphenicol, patients should undergo regular monitoring following the treatment. Even once patients have recovered from the infection and been discharged from the hospital, regular outpatient consultations should take place to ensure that the Chloramphenicol is not likely to have any long-term adverse effects on the patient.

Before receiving treatment with Chloramphenicol, patients or their next-of-kin should inform their doctor of any allergies which may be present. In the unlikely event that the patient develops an allergic reaction to the medication, medical staff should be informed immediately. An allergic reaction to a medicine can present as a life-threatening emergency and action should be taken immediately.

Storage

If patients are given Chloramphenicol by intravenous injection or intravenous infusion, the medicine will be administered by a medical professional. As this is done in a clinical setting, medical staff will be responsible for the storage of Chloramphenicol.

Although patients receiving Chloramphenicol orally will usually be treated in a clinical setting, there may be instances in which Chloramphenicol is prescribed for use at home. If patients are prescribed Chloramphenicol capsules or liquid to take at home, it is essential that they store the medication safely.

Chloramphenicol should be kept in a locked cabinet or medicine box so that no-one can access it. Children and pets, for example, should not be able to gain access to the medicine at any time.

Unless otherwise instructed, patients should keep the medicine at room temperature and away from heat, direct light and moisture. Chloramphenicol should not be frozen.

If patients are advised to stop taking Chloramphenicol or if they have medication left over, they should seek medical advice so that it can be disposed of properly. Similarly, if the medication reaches its use-by date, the patient will need to discard the medicine. Under no circumstances should Chloramphenicol be disposed of with regular household waste.

Instead, patients should contact their doctor or pharmacist and determine how to dispose of the medication safely. In most cases, medical clinics and/or pharmacists will dispose of the medication on behalf of the patient.

Summary

Although Chloramphenicol is effective in treating bacterial infections, it should only be used when it is absolutely necessary. Chloramphenicol is not appropriate for use on mild or moderate bacterial infections and other antibiotic treatments should be given prior to using Chloramphenicol.

If other treatment has been unsuccessful, physicians may decide to prescribe Chloramphenicol orally or via intravenous injection or infusion. Whilst the medication can be used to treat severe bacterial infections, it does carry some risks.

Patients and their next-of-kin should be made aware of the risks associated with Chloramphenicol before treatment commences. Providing they give their consent, Chloramphenicol can be used to reduce the symptoms of serious bacterial infections and rid the body of the infection completely. As the medication is only used on the most serious of bacterial infections, it is considered to be a life-saving drug and often prevents otherwise fatal infections from spreading.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 27, 2018
Content Source: