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Privacy Policy Terms of Use. It causes mild anemia, with thrombocytopenia and neutropenia. The second form is an idiosyncratic reaction that has a later onset and is more likely to be fatal after pancytopenia develops. This type is unpredictable, irreversible, and dose-independent. Besides causing fatal aplastic anemia and bone marrow suppression, other side effects of chloramphenicol include ototoxicity with the use of topical ear drops, gastrointestinal reactions such as oesophagitis with oral use, neurotoxicity, and severe metabolic acidosis.
Optic neuritis is the most commonly associated neurotoxic complication that can arise from chloramphenicol use. It may also present with peripheral neuropathy, which may present as numbness or tingling.
If optic neuropathy occurs, the drug should be withdrawn immediately, which will usually lead to partial or complete recovery of vision. Acute porphyria is an absolute contraindication to the use of chloramphenicol.
Signs of anaphylactic reaction to the medication include angioedema, bronchospasm, and urticaria. This reaction often presents 24 to 72 hours after the application of the medication with swelling and erythema. Moreover, due to the potential risk of toxicity to neonates, chloramphenicol should also not be prescribed in neonates less than one week old, especially preterm infants.
Currently, it is classed as a pregnancy category C drug and should be avoided in pregnancy or breastfeeding. However, there have been studies that show no associated teratogenicity with chloramphenicol use during the first trimester of pregnancy.
With parenteral or oral administrations, plasma concentrations of the drug should be monitored, especially in the elderly, in children less than four years old, and those with hepatic impairment. These blood tests include a complete blood count, urea and electrolytes, renal function tests, and liver function tests.
Female patients should have their pregnancy tests performed before starting the medication. Also, patients should be made aware of signs and symptoms associated with aplastic anemia, and be encouraged to report them should they occur during their treatment. These signs and symptoms include pallor, excessive tiredness, easy bruising, petechial rash, bleeding gums or epistaxis, and increased frequency of developing infections. 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. 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.
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.
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