Makindo Medical Notes

⚠️ Aplastic anaemia is usually fatal – chloramphenicol should only be used for life-threatening infections when safer alternatives are not available.

📖 About

Always check the BNF link here.

• 💊 Potent broad-spectrum antibiotic with excellent CSF penetration.
• 💉 Reserved for bacterial meningitis when cephalosporins or penicillins cannot be used.
• 👁️ Widely used topically (eye/ear drops) for superficial infections.

⚙️ Action

• 🛑 Bacteriostatic (can be bactericidal against some organisms in CSF).
• 🔗 Binds to the 50S ribosomal subunit → inhibits bacterial protein synthesis.

💉 Indications

• 🧠 Bacterial meningitis (if penicillin/cephalosporin contraindicated).
• 🦠 Haemophilus influenzae infections (e.g. meningitis, epiglottitis).
• 🌍 Typhoid fever (rare use in UK, more relevant globally).
• 👁️ Topical: conjunctivitis, otitis externa.

🔄 Interactions

• ⚠️ Potent CYP450 inhibitor (CYP2C19, CYP3A4).
• ⬆️ Increases toxicity of phenytoin and warfarin → monitor INR closely.
• 📌 Always check BNF/datasheet for full interaction list.

⚠️ Cautions

• 💧 Use with caution in renal or hepatic impairment.
• 💉 Immunisations should be delayed until the course is finished.
• 👵 Monitor drug levels in elderly patients.

⛔ Contraindications

• 🚫 Pregnancy.
• 🚫 Breastfeeding.
• 🚫 Porphyria.

💥 Side Effects

• 🩸 Bone marrow suppression – reversible, dose-related.
• ☠️ Aplastic anaemia – rare, unpredictable, potentially fatal (≈1 in 24,000–40,000).
• 👁️ Optic neuritis, peripheral neuritis.
• 👅 Stomatitis, glossitis.
• 👶 Grey baby syndrome in neonates (immature metabolism → CV collapse).
• 🧠 Headache, depression (rare).

📊 Dose

• 💊 50 mg/kg/day in 4 divided doses IV or PO.
• 📌 Monitor levels, especially in elderly or liver disease.   • Peak (1 hr post-dose): 15–25 mg/L.   • Trough (pre-dose): <15 mg/L.
• 🧪 Monitor FBC and Hb during prolonged use.