Chloramphenicol

 Risk Factor: C
 Class: ANTI-INFECTIVES / Antibiotics/Anti-infectives

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

No reports linking the use of chloramphenicol with congenital defects have been located. The drug crosses the placenta at term producing cord serum concentrations 30%106% of maternal levels (1,2).

The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 98 of whom had 1st trimester exposure to chloramphenicol (3, pp. 297301). For use anytime in pregnancy, 348 exposures were recorded (3, p. 435). In neither group was evidence found to suggest a relationship to large categories of major or minor malformations or to individual defects. A 1977 case report described a 14-day course of IV chloramphenicol, 2 g daily, given to a patient with typhoid fever in the 2nd trimester (4). A normal infant was delivered at term. Twenty-two patients, in various stages of gestation, were treated with chloramphenicol for acute pyelonephritis (5). No difficulties in the newborn could be associated with the antibiotic. In a controlled study, 110 patients received one to three antibiotics during the 1st trimester for a total of 589 weeks (6). Chloramphenicol was given for a total of 205 weeks. The incidence of birth defects was similar to that in controls.

Although apparently nontoxic to the fetus, chloramphenicol should be used with caution at term. Although specific details were not provided, one report claimed that cardiovascular collapse (gray syndrome) developed in babies delivered from mothers treated with chloramphenicol during the final stage of pregnancy (7). Additional reports of this severe adverse effect have not been located, although it is well-known that newborns exposed directly to high doses of chloramphenicol may develop the gray syndrome (8, 9). Because of this risk, some authors consider the drug to be contraindicated during pregnancy (10).

Breast Feeding Summary

Chloramphenicol is excreted into human breast milk. Two milk samples, separated by 24 hours in the same patient, were reported as 16 and 25 mg/mL, representing milk:plasma ratios of 0.51 and 0.61, respectively (11). Both active drug and inactive metabolite were measured. No effect on the infant was mentioned. No infant toxicity was mentioned in a 1964 report that found peak levels occurring in milk 13 hours after a single 1-g oral dose (12). In a similar study, continuous excretion of chloramphenicol into breast milk was established after the 1st day of therapy (13). Minimum and maximum milk concentrations were determined for five patients receiving 250 mg orally every 6 hours (0.54 and 2.84 mg/mL) and for five patients receiving 500 mg orally every 6 hours (1.75 and 6.10 mg/mL). No infant data were given.

The safety of maternal chloramphenicol consumption and breast feeding is unknown. The American Academy of Pediatrics classifies the antibiotic as an agent whose effect on the nursing infant is unknown but may be of concern because of the potential for idiosyncratic bone marrow suppression (14). Another publication recommended that chloramphenicol not be used in the lactating patient (15). Milk levels of this antibiotic are too low to precipitate the gray syndrome, but a theoretical risk does exist for bone marrow depression. Two other potential problems of lesser concern involve the modification of bowel flora and possible interference with the interpretation of culture results if a fever workup is required. Several adverse effects were reported in 50 breast-fed infants whose mothers were being treated with chloramphenicol including refusal of the breast, falling asleep during feeding, intestinal gas, and heavy vomiting after feeding (16).

References

1. Scott WC, Warner RF. Placental transfer of chloramphenicol (Chloromycetin). JAMA 1950;142:13312.
2. Ross S, Burke RG, Sites J, Rice EC, Washington JA. Placental transmission of chloramphenicol (Chloromycetin). JAMA 1950;142:1361.
3. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
4. Schiffman P, Samet CM, Fox L, Neimand KM, Rosenberg ST. Typhoid fever in pregnancy-with probable typhoid hepatitis. NY State J Med 1977;77:17789.
5. Cunningham FG, Morris GB, Mickal A. Acute pyelonephritis of pregnancy: a clinical review. Obstet Gynecol 1973;42:1127.
6. Ravid R, Roaff R. On the possible teratogenicity of antibiotic drugs administered during pregnancy. In Klingberg MA, Abramovici H, Chemke J, eds. Drugs and Fetal Development. New York, NY:Plenum Press, 1972:50510.
7. Oberheuser F. Praktische Erfahrungen mit Medikamenten in der Schwangerschaft. Therapiewoche 1971;31:2200. As reported in Manten A. Antibiotic drugs. In Dukes MNG, ed. Meyler's Side Effects of Drugs. Volume VIII. New York, NY:American Elsevier, 1975:604.
8. Sutherland JM. Fatal cardiovascular collapse of infants receiving large amounts of chloramphenicol. J Dis Child 1959;97:7617.
9. Weiss CV, Glazko AJ, Weston JK. Chloramphenicol in the newborn infant. A physiologic explanation of its toxicity when given in excessive doses. N Engl J Med 1960;262:78794.
10. Schwarz RH, Crombleholme WR. Antibiotics in pregnancy. South Med J 1979;72:13158.
11. Smadel JE, Woodward TE, Ley HL Jr, Lewthwaite R. Chloramphenicol (Chloromycetin) in the treatment of Tsutsugamushi disease (scrub typhus). J Clin Invest 1949;28:1196215.
12. Prochazka J, Havelka J, Hejzlar M. Excretion of chloramphenicol by human milk. Cas Lek Cesk 1964;103:37880.
13. Prochazka J, Hejzlar M, Popov V, Viktorinova D, Prochazka J. Excretion of chloramphenicol in human milk. Chemotherapy 1968;13:20411.
14. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:13750.
15. Anonymous. Update: drugs in breast milk. Med Lett Drugs Ther 1979;21:214.
16. Havelka J, Frankova A. Contribution to the question of side effects of chloramphenicol therapy in newborns. Cesk Pediatr 1972;21:313.
    
    

Questions and Answers

Chloramphenicol?, I just movd to UK and their meds a very different. I can't even find Neosporin!! Well, I got some antibacterial eye drops, because it looks like i have pink eye. the active antibiotic is chloramphenicol. I've never had it before. I administered the drops, and a few minutes later, I could almost taste it running down my throat. I began to feel a bit like i was going to throw up. It's gone now though.
I looked at side effects, and nasea and vomiting were 'potential' side effects. Has anyone ever taking these? Is the 'draining' feeling normal? it taste horrible >.<

The drops should drain into the nose - not down the throat. If they are going down the throat, this is not so good. Chloramphenicol has been known to give people permanent aplastic anemia (ie it kills off the bone marrow cells that make all blood cells.)
I had them once for the same reason and did not have this side effect.

I have been advised to use Chloramphenicol eyedrops (antibiotic. Will it stop my pill from working?, I have been advised to use Chloramphenicol eyedrops (which are an antibiotic, but available over the counter).

I have begum taking them as instructed, and know I must use extra contraception as the drops can stop The Pill from working. But as sperm can live inside you for 3-5 days, won't it stop my Pill from last night working? And leave me open to pregnancy?

You better call your gynecologist to find that one out.

How does Chloramphenicol work?, Explain how chloramphenicol works by describing the basic processes of protein synthesis. Please help, and please post any good sites/figures that you know.

Heya, for protein synthesis it's easier to learn through diagrams and videos. Here's one of the many on youtube (they even have a protein synthesis dance made in the seventies!): http://nz.youtube.com/watch?v=B6O6uRb1D3...

http://www.experiencefestival.com/a/Chlo...

Apparently Chloramphenicol acts by binding to the ribosomal complex and stopping the peptidyl transferase action. This is when the amino acid from the new tRNA molecule in the A site is transferred to the growing chain in E site. Basically this is the step where the 'adding' happens and the result is a peptide bond.
If this is blocked then the synthesis is very efficiently blocked.

Peruse the sites and good luck!

why is there an extremely strong bitter taste in my mouth after i use the eyedrop with chloramphenicol???,

May possibly be because the eyedrops are going through your tear ducts, draining into your nasal passages then going down your throat where you tongue is getting into contact with it.


In response to Yat Sen...if you are implying that your tear ducts are not connected to your nasal passages have you ever wondered 2 things..

1. WHere do the tears go that are caught by the tear ducts?
2. Why does my nose run like crazy when I cry or have watery eyes?

i recently had an operation on my eye and am now taking chloramphenicol redudriops.?, i was swallowed a drop by accident is this dangerous?

No

My husband is allergic to certain antibiotics, can chloramphenicol eye drops cause a stomach upset?,

You definitely can absorb eye drops into your system...beta blocker eye drops can and do cause slow heart rates. Chloramphenicol is usually well tolerated but could cause problems if he is allergic. Talk to your pharmacist/GP but don't panic as stomach upset isn't a severe allergic reaction...it's just annoying. Be concerned about rashes, shortness of breath or collapse (worse-case scenario...so don't expect last one)

what else can i do after i put chloramphenicol to eye of my dog?, does it work 100%?

Just put in the chloramphenicol drops as directed but your vet and leave the eye well alone otherwise. You don't say why it's being given, so it's hard to advise.
Chloramphenicol is a very good antibiotic eye drop. If symptoms persist after the directed course, or if things get worse in the meantime then go back to your vet.

your experiment esultss indicate thet antibiotics such as tetracycline, chloramphenicol, and streptomycin have, your experiment esultss indicate thet antibiotics such as tetracycline, chloramphenicol, and streptomycin have a broad spectrum of activity against prokaryotic cells.why do these antibiotics lack inhibitory activity against eukaryotic cells such as fungi?

Firstly, u need to know chemistry in order to prescribe a good medication such as H2S04 and nitrate

hi i used chloramphenicol eye drops in my 2nd trimester of pregnancy?, i was told it was ok til 3rd trimester thats when it can cause problems,has anyone else use these in pregnancy? or does anyone know about it xxxx

i dont know much of this drug but i do know you are not suppose to use it during any part of your pregnancy it can make the baby very sick, unless the risk of not using it is greater to you. sorry it not very helpful but i would talk to your doctor about it more. my aunt did use them for two days and my cousin came out just fine.