BMA Concise Guide to Medicine & Drugs

Chloramphenicol

Brand names Boots Antibiotic Eye Drops, Brochlor, Chloromycetin, Kemicetine, Minims Chloramphenicol, Optrex Infected Eyes

Used in the following combined preparation Actinac

QUICK REFERENCE

Drug group Antibiotic

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes (except some eye drops)

Available as generic Yes

GENERAL INFORMATION

Chloramphenicol is an antibiotic used topically to treat eye and ear infections. Eye drops are available over the counter. Given by mouth or injection, it is used in the treatment of meningitis and brain abscesses. It is also effective in acute infections such as typhoid, pneumonia, epiglottitis, or meningitis caused by bacteria resistant to other antibiotics. Although most people experience few adverse effects, chloramphenicol occasionally causes serious or even fatal blood disorders. For this reason, chloramphenicol by mouth or injection is normally only given (usually in hospital) to treat life-threatening infections that do not respond to safer drugs.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Capsules, injection, lotion, eye ointment, eye and ear drops.

Frequency and timing of doses Every 6 hours (by mouth or injection); every 2–6 hours (eye preparations); 2–3 x daily (ear drops).

Adult dosage range Varies according to preparation and condition. Follow your doctor’s instructions.

Onset of effect 1–3 days, depending on the condition and preparation.

Duration of action 6–8 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose For skin, eye, and ear preparations, apply as soon as you remember. Other preparations are usually given in hospital.

Stopping the drug Take the full course. Even if you feel better the infection may still be present and may recur if treatment is stopped too soon.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Transient irritation may occur with eye or ear drops. Other forms of the drug may cause nausea, vomiting, diarrhoea, numbness or tingling in the hands or feet, or a rash; discuss with your doctor if the gastrointestinal symptoms are severe or if you develop numbness, tingling, or a rash. If you experience impaired vision or a painful mouth or tongue, stop taking the drug and consult your doctor immediately. A sore throat, fever, and unusual tiredness or weakness with any form of the drug may be signs of blood abnormalities and should be reported to your doctor without delay, even if treatment has stopped. If these effects occur during treatment, stop taking the drug and contact your doctor immediately.

INTERACTIONS (ORAL AND INJECTION ONLY)

General note Chloramphenicol may increase the effect of certain other drugs, including phenytoin, oral anticoagulants, and oral antidiabetics; phenobarbital or rifampicin may reduce the effect of chloramphenicol.

Antidiabetic drugs Chloramphenicol may increase the effect of antidiabetic drugs.

Ciclosporin, tacrolimus, and sirolimus Chloramphenicol capsules, liquid, or injection may raise blood levels of these drugs.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have a blood disorder.

· You are taking other medicines.

Pregnancy No evidence of risk with eye or ear preparations. Safety in pregnancy, of other methods of administration, not established. Discuss with your doctor.

Breast-feeding No evidence of risk with eye or ear preparations. Taken by mouth, the drug passes into the breast milk and may increase the risk of blood disorders in the baby. Discuss with your doctor.

Infants and children Over-the-counter preparations should not be used in infants under 2 years. Other preparations are rarely used in infants and children, and then only under medical supervision.

Over 60 No problems expected.

Driving and hazardous work Avoid such activities until you have learned how chloramphenicol eye drops affect your vision; the drug can cause transient stinging or blurred vision after application.

Alcohol No known problems.

PROLONGED USE

Rarely, prolonged or repeated use may increase the risk of serious blood disorders. Prolonged or repeated use of eye drops may make the drug less effective at treating eye infections.

Monitoring Patients given the drug by mouth or injection may have periodic blood cell counts and eye tests. In the rare cases when chloramphenicol is given to infants by mouth or injection, blood levels of the drug are usually monitored.