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ACUTE EXPOSURE INFORMATION
- USES: Chloramphenicol is a broad spectrum antibiotic that is rarely used in the United States. It is an alternative therapy for bacterial meningitis, brain abscess, meliodosis, rickettsial infections, typhoid fever, and invasive salmonellosis.
- PHARMACOLOGY: In therapeutic doses, chloramphenicol inhibits protein synthesis by reversibly binding to the 50S and 70S subunit of the ribosome. It is bacteriostatic in most organisms, but bacteriocidal against H. influenza, S. pneumonia, and N. meningitidis.
- TOXICOLOGY: Chloramphenicol causes a dose-related bone marrow suppression, as well as idiosyncratic aplastic anemia. "Gray baby syndrome" of neonates (abdominal distention, vomiting, flaccidity, cyanosis, circulatory collapse, and death) occurs due to decreased metabolism of chloramphenicol in the immature liver.
- EPIDEMIOLOGY: Chloramphenicol is rarely used in the United States anymore, but remains the drug of choice for typhoid fever in several countries. Consequently, exposure and fatalities are extremely rare in the United States. Fatality rates as high as 50% have been reported in patients presenting with aplastic anemia or "gray baby syndrome".
- WITH THERAPEUTIC USE
- Adverse effects include dose dependent bone marrow suppression that is generally reversible with discontinuation of therapy. Idiosyncratic aplastic anemia can occur; it is not dose-related, occurs within 5 months of treatment, has a 50% mortality rate, and confers a future risk of non-lymphocytic leukemia. "Gray baby syndrome" can occur in neonates receiving chloramphenicol. Affected infants exhibit vomiting, anorexia, respiratory distress, abdominal distention, green stools, cyanosis, ashen color, metabolic acidosis, hypotension, and cardiovascular collapse. Mortality rates as high as 40% have been reported, with most surviving patients exhibiting long term sequelae.
- WITH POISONING/EXPOSURE
- MILD TO MODERATE TOXICITY: Chloramphenicol produces nausea and vomiting in overdose. Confusion and delirium, optic neuritis, and contact dermatitis can occur.
- SEVERE TOXICITY: Myocardial depression resulting in cardiovascular collapse can occur within 12 hours of ingestion.
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