Chloramphenicol: A review of its use in clinical practice

Chloramphenicol has certain notable characteristics: it penetrates reliably into the central nervous system; it is usually bacteriostatic, but is bactericidal for Hemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis; it is metabolized in the liver, and levels of drug in serum need to be monitored in patients with liver disease and in neonates. Potential toxicity limits the use of this drug. It has been estimated that death from aplastic anemia occurs in oe of 24,500-40,800 courses of treatment. The incidence of aplastic anemia after parenteral therapy is unknown; however, only a few cases have been reported. The gray baby syndrome occurred in premature and newborn infants receiving high or unmodified doses of chloramphenicol. This condition can be avoided by reduction of dosage and by monitoring levels of drug in the serum of these infants. The most common toxicity is a reversible, dose-related bone marrow suppression, which is identified by serial monitoring of reticulocyte and complete blood cell counts. Many of the indications for use of this drug are still controversial because studies comparing the toxicity and efficacy of chloramphenicol and of alternative antibiotics have not been done.