Serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, and granulocytopenia) are known to occur after the administration of chloramphenicol. In addition, there have been reports of aplastic anemia attributed to chloramphenicol which later terminated in leukemia. Blood dyscrasias have occurred after both short-term and prolonged therapy with this drug. Chloramphenicol must not be used when less potentially dangerous agents will be effective, as described in the INDICATIONS AND USAGE section. It must not be used in the treatment of trivial infections or where it is not indicated, as in colds, influenza, infections of the throat; or as a prophylactic agent to prevent bacterial infections.
Precautions: It is essential that adequate blood studies be made during treatment with the drug. While blood studies may detect early peripheral blood changes, such as leukopenia, reticulocytopenia, or granulocytopenia, before they become irreversible, such studies cannot be relied on to detect bone marrow depression prior to development of aplastic anemia. To facilitate appropriate studies and observation during therapy, it is desirable that patients be hospitalized.
Chloromycetin® Sodium Succinate
(sterile chloramphenicol sodium succinate, USP)
IMPORTANT CONSIDERATIONS IN PRESCRIBING INJECTABLE CHLORAMPHENICOL SODIUM SUCCINATE
CHLORAMPHENICOL SODIUM SUCCINATE IS INTENDED FOR INTRAVENOUS USE ONLY. IT HAS BEEN DEMONSTRATED TO BE INEFFECTIVE WHEN GIVEN INTRAMUSCULARLY.
Chloramphenicol sodium succinate must be hydrolyzed to its microbiologically active form, and there is a lag in achieving adequate blood levels compared with the base given intravenously.
Patients started on intravenous chloramphenicol sodium succinate should be changed to the oral form of another appropriate antibiotic as soon as practicable.
Chloramphenicol is an antibiotic that is clinically useful for, and should be reserved for, serious infections caused by organisms susceptible to its antimicrobial effects when less potentially hazardous therapeutic agents are ineffective or contraindicated. Sensitivity testing is essential to determine its indicated use, but may be performed concurrently with therapy initiated on clinical impression that one of the indicated conditions exists (see INDICATIONS AND USAGE section).
In accord with the concepts in the Warning Box and this INDICATIONS AND USAGE section, chloramphenicol must be used only in those serious infections for which less potentially dangerous drugs are ineffective or contraindicated. However, chloramphenicol may be chosen to initiate antibiotic therapy on the clinical impression that one of the conditions below is believed to be present; in vitro sensitivity tests should be performed concurrently so that the drug may be discontinued as soon as possible if less potentially dangerous agents are indicated by such tests. The decision to continue use of chloramphenicol rather than another antibiotic when both are suggested by in vitro studies to be effective against a specific pathogen should be based upon severity of the infection, susceptibility of the pathogen to the various antimicrobial drugs, efficacy of the various drugs in the infection, and the important additional concepts contained in the Warning Box above.
1. Acute infections caused by Salmonella typhi*
It is not recommended for the routine treatment of the typhoid carrier state.
2. Serious infections caused by susceptible strains in accordance with the concepts expressed above:
a) Salmonella species
b) H. influenzae, specially meningeal infections
d) Lymphogranuloma-psittacosis group
e) Various gram-negative bacteria causing bacteremia, meningitis, or other serious gram-negative infections
f) Other susceptible organisms which have been demonstrated to be resistant to all other appropriate antimicrobial agents.
3. Cystic fibrosis regimens
*In treatment of typhoid fever some authorities recommend that chloramphenicol be administered at therapeutic levels for 8 to 10 days after the patient has become afebrile to lessen the possibility of relapse.
Media Articles Related to Chloromycetin (Chloramphenicol)
FDA Warns About GI Product
Source: MedPage Today Product Alert [2012.09.19]
WASHINGTON -- The FDA has issued a warning against use of the Mexican remedy Intestinomicina, which contains chloramphenicol, a potentially fatal ingredient that has been withdrawn from the market.
Published Studies Related to Chloromycetin (Chloramphenicol)
Gatifloxacin versus chloramphenicol for uncomplicated enteric fever: an open-label, randomised, controlled trial. [2011.06]
BACKGROUND: We aimed to investigate whether gatifloxacin, a new generation and affordable fluoroquinolone, is better than chloramphenicol for the treatment of uncomplicated enteric fever in children and adults... INTERPRETATION: Although no more efficacious than chloramphenicol, gatifloxacin should be the preferred treatment for enteric fever in developing countries because of its shorter treatment duration and fewer adverse events. FUNDING: Wellcome Trust. Copyright (c) 2011 Elsevier Ltd. All rights reserved.
Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial. [2009.01.15]
OBJECTIVE: To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery... CONCLUSION: Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant. Trial registration Current Controlled Trials ISRCTN73223053.
Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2-59 months in low resource settings: multicentre randomised controlled trial (SPEAR study). [2008.01.12]
OBJECTIVE: To evaluate whether five days' treatment with injectable ampicillin plus gentamicin compared with chloramphenicol reduces treatment failure in children aged 2-59 months with community acquired very severe pneumonia in low resource settings... CONCLUSION: Injectable ampicillin plus gentamicin is superior to injectable chloramphenicol for the treatment of community acquired very severe pneumonia in children aged 2-59 months in low resource settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN39543942.
Randomised equivalency trial comparing 2.5% povidone-iodine eye drops and ophthalmic chloramphenicol for preventing neonatal conjunctivitis in a trachoma endemic area in southern Mexico. [2007.11]
AIM: To evaluate the effectiveness of 2.5% povidone-iodine eye drops (PIED) compared with ophthalmic chloramphenicol (OC) for preventing neonatal conjunctivitis... CONCLUSIONS: PIED seems to increase the risk of acquiring chlamydial conjunctivitis in neonates. Additional measures are required to prevent mother to fetus transmission of chlamydial infection during pregnancy, delivery, and after birth.
Open-label randomized trial of oral trimethoprim-sulfamethoxazole, doxycycline, and chloramphenicol compared with trimethoprim-sulfamethoxazole and doxycycline for maintenance therapy of melioidosis. [2005.10]
Melioidosis (infection caused by Burkholderia pseudomallei) requires a prolonged course of oral antibiotics following initial intravenous therapy to reduce the risk of relapse after cessation of treatment. The current recommendation is a four-drug regimen (trimethoprim [TMP], sulfamethoxazole [SMX], doxycycline, and chloramphenicol) and a total treatment time of 12 to 20 weeks...
Clinical Trials Related to Chloromycetin (Chloramphenicol)
Ceftriaxone Versus Chloramphenicol for Treatment of Severe Pneumonia in Children [Recruiting]
Acute lower respiratory tract infections are a leading cause of morbidity and mortality in
sub Saharan Africa. The World Health Organisation (WHO) still recommends intravenous
chloramphenicol for the treatment of severe pneumonia in children aged less than five years.
However, up to 20% of children fail treatment due to the emergence of resistance by
bacteria. Several centers now use ceftriaxone, a third generation cephalosporin, which is
reported to be efficacious in the treatment of severe pneumonia. However the high cost of
ceftriaxone is too prohibitive to allow for its routine use in resource constrained
countries. The purpose of this study is to compare chloramphenicol and ceftriaxone in the
treatment of severe pneumonia in children under five.
We hypothesize that 92. 7% of children who receive once daily intravenous ceftriaxone (75
mg/kg body weight)for 7 days, will recover from severe pneumonia compared to 80. 2 % of those
who receive intravenous chloramphenicol (25mg/kg body weight/dose every 6 hours for 7 days).
Patients Response to Early Switch To Oral:Osteomyelitis Study [Not yet recruiting]
Based on the current literature, investigators hypothesize that patients with osteomyelitis
who are treated with the standard approach of intravenous antibiotics for the full duration
of therapy will have the same clinical outcomes as patients treated with the experimental
approach of intravenous antibiotics with early switch to oral antibiotics.
The primary objective of this study is to compare patients with osteomyelitis treated with
the standard approach of intravenous antibiotics for the full duration of therapy versus
patients treated with intravenous antibiotics with an early switch to oral antibiotics in
relation to clinical outcomes at 12 months after discontinuation of antibiotic therapy.
Secondary objectives of the study include the evaluation of adverse events related to the
use of antibiotics as well as the cost of care evaluated from the hospital perspective.
Village Integrated Eye Workers Trial [Recruiting]
VIEW is a community-randomized trial designed to determine whether it is possible to prevent
corneal ulcers on a large scale. The study compares the incidence of corneal ulceration
between villages in which volunteers are trained to diagnose and treat corneal abrasions and
villages which receive no intervention.
Oral Glycerol and High-Dose Rectal Paracetamol to Improve the Prognosis of Childhood Bacterial Meningitis [Recruiting]
Bacterial meningitis remains a significant cause of morbidity and mortality in children,
especially in countries with limited resources. Efforts to improve the grim outcome have
included altering the first line antibiotic therapy, controlling seizures and managing
fluids more carefully. Adjuvant therapy of steroids has been used with limited success in
children in the West and with no proven value in Malawi and other resource constrained
settings. Glycerol has been used to reduce brain oedema in neurosurgery and it has recently
been shown to reduce morbidity in childhood meningitis in South America. Paracetamol in a
high dosage has been shown to reduce inflammation and cytokine levels in septicaemia with
improved outcomes in adults.
In Malawi the investigators have tried adjuvant steroids with no improvement in outcome of
childhood meningitis. They have recently concluded a study of ceftriaxone which has shown no
improvement in mortality though there is less hearing loss than with chloramphenicol and
Following the encouraging results of the Childhood South American Study it is important to
assess the use of adjuvant glycerol in children in the investigators' setting. Paracetamol
is routinely used in meningitis because of the accompanying fever and headache. This is an
opportunity to study its place as adjuvant therapy more carefully than has previously been
The investigators propose a prospective, randomized, double blind 2 by 2 factorial designed
study to assess the advantage of ceftriaxone (antibiotic) given with paracetamol and
glycerol in combination, singly or with neither adjuvant therapy in childhood bacterial
Long Term Protection by and Persistence of Vi Antibodies Induced by Vi-rEPA Conjugate Vaccines in Vietnamese Children Injected at 2-5 Years or at 5-8 Years of Age [Completed]
Typhoid fever remains an important cause of morbidity and mortality in the developing world.
It is estimated that more than 16 million cases and about 600,000 deaths occur annually, most
of which occur in Southeast Asia and Africa. Ingestion of food or water contaminated by
acutely infected persons or chronic carriers is the most common form of transmission. As a
result, typhoid fever is prevalent where unsafe drinking water or contaminated food is
Typhoid fever is highly endemic in Vietnam, especially in the southern provinces and is a
significant disease in both preschool and school-aged children. Data from Dong Thap
Provincial Hospital, Mekong delta region showed that among 3,934 hospitalized typhoid fever
cases from 1990 to 1995, 4. 2% had complications and 0. 8% died.
Typhoid fever has become difficult and expensive to treat. About 90% of Salmonella typhi
isolates are of multidrug-resistant (resistant to chloramphenicol, ampicillin, and
trimethoprim-sulfamethoxazole) and 76% of isolates showed reduced susceptibility to
fluoroquinolones. Isolates with full fluoroquinolone or extended spectrum cephalosporin
resistance have not yet reported in Vietnam but occur sporadically in the Indian
subcontinent. If they become widespread, alternative treatment options will be limited. The
improvement of sanitation, provision of safe water and elimination of chronic carriage is not
expected to be achieved quickly. Accordingly, vaccination against typhoid fever is
increasingly important national public health priority.
Page last updated: 2012-09-19