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Chloramphenicol is a medication used in the management and treatment of superficial eye infections such as bacterial conjunctivitis, and otitis externa. It has also been used for the treatment of typhoid and cholera. Chloramphenicol is an antibiotic and is in the class of antimicrobials that inhibits protein synthesis. This activity outlines the indications, action, and contraindications for Chloramphenicol as a valuable agent in the treatment of superficial eye infections, otitis externa, Typhoid fever, and other severe life-threatening conditions, especially those caused by Haemophilus influenza. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the healthcare team in the management of patients with the infections stated above. Objectives: Identify the mechanism of action and administration of chloramphenicol. Describe the adverse effects and contraindications of chloramphenicol. Review the appropriate monitoring and toxicity of chloramphenicol. Summarize interprofessional team strategies for improving care coordination and communication to advance the prescription and use of chloramphenicol and improve outcomes. Access free multiple choice questions on this topic.

Chloramphenicol can be fatal in an overdose; this usually occurs with intravenous administration of the drug and is more likely to affect infants. Symptoms of poisoning include nausea and vomiting, abdominal distension, metabolic acidosis, hypotension, hypothermia, cardiovascular collapse, and coma. Grey baby syndrome is a well-known condition that arises from chloramphenicol toxicity in infants, especially affecting preterm neonates. It can also affect breastfed infants whose mothers are taking oral chloramphenicol.[31] A preterm neonate is more likely to be affected as their immature liver is unable to produce enough UDP-glucuronyltransferase enzyme needed to metabolize chloramphenicol, by glucuronidation, for renal excretion. The resultant accumulation of chloramphenicol in the infant will lead to gray baby syndrome. Symptoms of the grey baby syndrome vary depending on the serum concentration of the drug in the body. Examples of signs and symptoms of toxicity include poor feeding, irritability, abdominal distension, vomiting, grey skin discoloration, and sudden collapse from cardiovascular and respiratory complications.[32][33][34] Due to the possible risk of fatality associated with chloramphenicol exposure in neonates, an alternative drug should always be considered for breastfeeding mothers. However, if chloramphenicol is the therapeutic choice, close monitoring of the infant is required.

As with any medication, the prescription of chloramphenicol will require an interprofessional healthcare team to ensure safe prescribing of this antibiotic and maximum benefits attained by patients from its administration. This international healthcare team will consist of nurses, pharmacists, and physicians involved in the care of the patient. Prior to the initiation of the antibiotic, the physician should always get a thorough drug history from the patient to identify any potential allergy with chloramphenicol. Moreover, for female patients of child-bearing age, nurses can help with ensuring that they receive pregnancy testing, and a negative pregnancy status confirmed before patients start on the drug. The pharmacist can also work with the doctor to check that the patient receives the right dose, route, and frequency of the medication. Also, due to the risk of bone marrow suppression associated with chloramphenicol use, both the doctor and the pharmacist need to check for concomitant usage of other medications that also carries the risk of decreasing blood cell counts. Examples of drugs that can also cause bone marrow suppression include rifampicin, carbimazole, and trimethoprim. These medications should not be administered together with chloramphenicol. Nurses involved in the care of the patient can collaborate with physicians to ensure laboratory tests are performed regularly during the treatment for early detection of decreases in blood cell counts. Lastly, physicians, nurses, and pharmacists all share the responsibility of providing adequate patient education regarding the drug. Patients should understand the signs and symptoms suggestive of an adverse reaction to chloramphenicol that they can look out for and report. Proper patient education on the use of chloramphenicol can also help improve patients’ compliance and adherence to the medication.