Chloramphenicol prescription. Chloramphenicol description of the trade name: instructions and analogues. The use of chloramphenicol in various diseases

Chloramphenicol inhibits the enzyme peptidyltransferase, which leads to disruption of protein formation in the cell of the microorganism. After oral administration, it is absorbed quickly from the gastrointestinal tract, bioavailability is 75–90%, the maximum concentration in the blood plasma is achieved within 2–3 hours, and the therapeutic concentration is maintained for 4–5 hours. Binds to plasma proteins by 50–60%. Chloramphenicol penetrates into body fluids and organs, through the placental and blood-brain barrier, and is excreted in breast milk. The content of chloramphenicol in the cerebrospinal fluid is 2 times less than in plasma. Most of the drug is biotransformed in the liver; the resulting metabolites, as well as approximately 10% of the unchanged drug, are excreted by the kidneys, and chloramphenicol is partially excreted in feces and bile. In the intestine, chloramphenicol is hydrolyzed by intestinal bacteria to form inactive metabolites. When instilled into the conjunctival sac, chloramphenicol creates sufficient antibacterial concentrations in the aqueous humor of the eye and also partially enters the systemic circulation. Chloramphenicol is active against most gram-negative cocci (meningococci and gonococci), gram-positive cocci (streptococci, staphylococci, enterococci, pneumococci), bacteria (Haemophilus influenzae and Escherichia coli, Shigella, Salmonella, Klebsiella, Yersinia, Serration, Proteus), spirochetes, rickettsia, anaerobes, some large viruses (pathogens of psittacosis, trachoma, lymphogranulomatosis inguinal and others); acts on strains that are resistant to penicillin, sulfonamides, streptomycin. Chloramphenicol is weakly active against Pseudomonas aeruginosa, acid-fast bacteria, protozoa and clostridia. Resistance of microorganisms to chloramphenicol develops relatively slowly. Since chloramphenicol has serious side effects, it is used when other chemotherapy drugs are ineffective.

Indications

For systemic use (orally and parenterally): paratyphoid fever, typhoid fever, salmonellosis (generalized forms), rickettsiosis (including Rocky Mountain spotted fever, typhus, Q fever), brucellosis, tularemia, brain abscess, dysentery, meningococcal infection, lymphogranuloma inguinale , trachoma, chlamydia, ehrlichiosis, yersiniosis, urinary tract infections, purulent peritonitis, purulent wound infection, biliary tract infections. Liniment ophthalmic, eye drops: bacterial infections of the eye, including keratitis, conjunctivitis, keratoconjunctivitis, episcleritis, blepharitis, scleritis. For external use: bacterial skin infections, including boils, trophic ulcers, infected burns, wounds, bedsores, cracked nipples in nursing mothers.

Method of administration of chloramphenicol and dose

Chloramphenicol is taken orally, administered intravenously, intramuscularly, used conjunctivally, cutaneously. The dosage regimen is set individually. Take orally 0.5 hour before meals (for nausea and vomiting, take 1 hour after meals). For adults, a single dose is 0.25 – 0.5 g; the daily dose is 2.0 g (in very severe cases, it is possible to increase to 4 g, under the strict supervision of a doctor and monitoring of kidney function and the state of the blood picture). The daily dose should be divided into 3 to 4 doses. For children under 3 years old, a single dose is 10–15 mg/kg body weight, 3–8 years old - 0.15–0.2 g, over 8 years old – 0.2–0.3 g; take 3 – 4 times a day. The duration of therapy is 7–10 days (subject to good tolerance and indications, it can be used for up to 14 days). It is administered conjunctivally for the treatment of purulent-inflammatory eye pathology and a 0.25% aqueous solution or 1% liniment is used. Cutaneously, locally: 5–10% liniment and alcohol solutions are applied several times a day to damaged areas of the skin (impregnated with sterile gauze pads or applied directly to the skin); Can be used with an occlusive dressing; Dressings are carried out after 1 - 3 days (possibly less often - after 4 - 5 days) until the wound is completely cleansed.

During therapy with chloramphenicol, regular monitoring of peripheral blood patterns is necessary. When treating cracked nipples in nursing mothers, cessation of breastfeeding of newborns is not required.

Contraindications for use

Hypersensitivity, acute intermittent porphyria, pathology of the hematopoietic organs, fungal skin diseases, severe disturbances in the functional state of the liver and/or kidneys, psoriasis, glucose-6-phosphate dehydrogenase deficiency, eczema, the neonatal period (up to 4 weeks) and early childhood.

Restrictions on use

Tendency to allergic diseases, pathology of the circulatory system.

Use during pregnancy and breastfeeding

During pregnancy, the use of chloramphenicol is possible if the expected effects of treatment are higher than the possible risk to the fetus (there are no strictly controlled and adequate studies on the use of chloramphenicol during pregnancy, it must be taken into account that chloramphenicol is able to penetrate the placenta). After oral administration, chloramphenicol passes into breast milk and may cause serious side effects in breastfed infants. When used topically, systemic absorption of the drug is possible. Therefore, nursing women should stop either using the drug or breastfeeding.

Side effects of chloramphenicol

Systemic effects: digestive system: nausea, dyspepsia, vomiting, irritation of the mucous membrane of the pharynx and mouth, diarrhea, dysbacteriosis;
blood (hemostasis, hematopoiesis): leukopenia, reticulocytopenia, thrombocytopenia, hypohemoglobinemia, aplastic anemia, agranulocytosis;
sense organs and nervous system: psychomotor disorders, delirium, headache, impaired consciousness, depression, optic neuritis, taste disturbance, auditory and visual hallucinations, decreased visual and hearing acuity;
allergic reactions: urticaria, skin rash, angioedema;
others: secondary fungal infection, dermatitis, cardiovascular collapse (in children under 1 year).
For conjunctival use and application to the skin: local allergic reactions.

Interaction of chloramphenicol with other substances

Ristomycin increases the hematotoxicity of chloramphenicol, cycloserine - the neurotoxicity of chloramphenicol. Phenobarbital accelerates biotransformation, reduces the concentration and duration of the effect of chloramphenicol. Chloramphenicol inhibits the metabolism of chlorpropamide, tolbutamide, and oxycoumarin derivatives (increases anticoagulation and hypoglycemic properties). Erythromycin, nystatin, levorin, oleandomycin increase the antibacterial activity of chloramphenicol, while benzylpenicillin salts reduce it. Chloramphenicol is incompatible with sulfonamides, cytostatics, pyrazolone derivatives, barbiturates, diphenin, and alcohol.

Overdose

In case of an overdose of chloramphenicol, cardiovascular syndrome (“gray syndrome”) develops in newborns and premature infants when treated with high doses (due to the accumulation of the drug, which is caused by the immaturity of liver enzymes, as well as the direct toxic effect of the drug on the myocardium), which manifests itself in a bluish-gray skin color , hypothermia, lack of reactions, arrhythmic breathing, cardiovascular failure, possible death (up to 40%). Required: symptomatic treatment, hemosorption.

And anaerobic infections. Used as a second line drug.

Mechanism of action

Chloramphenicol has a bacteriostatic effect, which is associated with disruption of protein synthesis by ribosomes. In high concentrations it has a bactericidal effect against pneumococcus, meningococcus and H.influenzae.

Activity spectrum

Chloramphenicol has a broad spectrum of antimicrobial activity, but over many years of use, a number of bacteria have become resistant.

Among gram-positive cocci, pneumococcus is the most sensitive to the drug, however, many penicillin-resistant strains are resistant. Enterococci are generally insensitive. Among staphylococci, more than 30% of strains are resistant. Of the gram-negative cocci, meningococci are the most sensitive.

Chloramphenicol acts on many gram-positive and gram-negative rods: H.influenzae(including ampicillin-resistant strains), E.coli, salmonella, shigella, pathogens of diphtheria, whooping cough, anthrax, brucellosis, plague. Resistance is often observed among enterobacteriaceae. In Russia, 50-90% of Shigella and 10% of Salmonella are resistant to chloramphenicol.

Spirochetes (leptospira, T. pallidum), rickettsia, actinomycetes. The drug has high activity against spore-forming and non-spore-forming anaerobes, including B.fragilis.

Pharmacokinetics

Chloramphenicol is well absorbed when taken orally, and bioavailability is not affected by food. The maximum concentration in the blood serum after oral administration is achieved after 1-3 hours, with intravenous administration - after 1-1.5 hours. It passes well through the blood-brain barrier and the placenta, and penetrates into breast milk. High concentrations are created in brain tissue, bronchial secretions, pleural and synovial fluids, low concentrations are created in bile. Concentrations in fetal serum may be 30-80% of maternal serum levels. Metabolized in the liver. In newborns and patients with severe liver failure, the biotransformation of chloramphenicol is slow and its accumulation is possible. Excretion is carried out by the kidneys mainly in an inactive state, therefore, in case of renal failure, no dose adjustment is required. The half-life in adults is 1.5-3.5 hours, in children it can increase to 6.5 hours, and in newborns - up to 24 hours or more. Hemodialysis does not remove chloramphenicol. Reducing the concentration of the drug in the blood is possible through hemosorption.

Parenteral chloramphenicol is administered in the form of microbiologically inactive succinate. Before activation occurs (by cleavage of the succinic acid residue), part of the drug can be excreted by the kidneys. Therefore, concentrations of chloramphenicol in the blood when administered parenterally, especially intramuscularly, may be lower than when administered orally.

When using ophthalmic dosage forms (drops, liniment), intraocular and partial systemic absorption of chloramphenicol occurs. High concentrations are created in the intraocular fluid.

Adverse reactions

Hematological reactions:

reversible (dose-dependent): reticulocytopenia, thrombocytopenia, anemia, leukopenia;

irreversible (does not depend on the dose, observed in people with a genetic predisposition): aplastic anemia, unfavorable prognosis. It is rare (one case in 25-40 thousand patients), and can develop after discontinuation of the drug, single and local use. In children it can be combined with the development of myeloblastic leukemia.

"Gray syndrome" of newborns: vomiting, bloating, respiratory distress, cyanosis. Later, vasomotor collapse, hypothermia, and acidosis occur. The cause of the development of “gray syndrome” is the accumulation of chloramphenicol, caused by the immaturity of liver enzymes, and its direct toxic effect on the myocardium. Mortality reaches 40%. Measures of assistance: exchange blood transfusion or hemosorption.

Nervous system: confusion, headache, peripheral polyneuropathy, mental disorders; with prolonged use, optic neuritis may develop with the threat of vision loss.

Gastrointestinal tract: glossitis, stomatitis, abdominal pain or discomfort, nausea, vomiting, diarrhea.

Local: burning, itching, swelling when using ophthalmic dosage forms.

Other: Jarisch-Herxheimer reaction (endotoxic reaction), described with the use of chloramphenicol in patients with syphilis, brucellosis and typhoid fever.

Indications

Systemically

For all of these infections, chloramphenicol is considered a second-line drug.

Locally

Contraindications

Allergic reaction to chloramphenicol.

Pregnancy.

Lactation.

Warnings

Hematotoxicity. When using chloramphenicol, a reversible decrease in the content of blood cells is possible, which is more often observed when using large doses (4 g or more per day), with long courses and high concentrations of the drug in the blood serum (25 mcg/ml or more). Risk groups include newborns and patients with liver diseases. For control, it is necessary to conduct a clinical blood test every 3 days with the determination of reticulocytes and platelets, as well as, if possible, TDM.

Pregnancy. The use of chloramphenicol during pregnancy is not recommended due to the risk of toxic effects on the fetus.

Lactation. Chloramphenicol passes into breast milk in high concentrations (including when using ophthalmic dosage forms) and can have a myelotoxic effect, so it should not be prescribed to nursing women.

Pediatrics. In newborns, the detoxifying function of the liver is not sufficiently developed, which contributes to the accumulation of chloramphenicol in toxic concentrations and can lead to the development of “gray syndrome”.

Liver dysfunction. In patients with impaired liver function, TDM should be performed.

Dentistry. The use of chloramphenicol leads to an increase in the frequency of microbial infections of the oral cavity, slower healing processes and bleeding of the gums, which may be a manifestation of myelotoxicity. Dental interventions should, if possible, be completed before starting therapy.

Previous treatment with cytostatics or radiation therapy. Possible accumulation of chloramphenicol and toxic reactions in the form of bone marrow suppression and liver dysfunction.

Therapeutic drug monitoring. To increase the safety of treatment with chloramphenicol, serum concentrations should be monitored whenever possible. The therapeutic range is 10-25 mcg/ml. Monitoring is especially necessary in neonates and patients with liver disease.

Drug interactions

By inhibiting microsomal liver enzymes, chloramphenicol increases the half-life and enhances the effects of oral antidiabetic drugs (sulfonylurea derivatives), phenytoin, warfarin.

Inducers of microsomal liver enzymes (rifampicin, phenobarbital and phenytoin) reduce the concentration of chloramphenicol in the blood serum.

Chloramphenicol may weaken the effectiveness of iron, folic acid and vitamin B12 supplements by reducing their stimulating effect on hematopoiesis.

When using chloramphenicol during radiation therapy, as well as when it is combined with cimetidine and cytostatics, the risk of developing aplastic anemia increases.

Patient Information

Chloramphenicol tablets and capsules should be taken with a full glass of water.

Strictly follow the prescribed regimen and treatment regimen throughout the course of therapy, do not miss a dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double doses.

Follow the rules for using ophthalmic dosage forms.

Avoid, if possible, repeated courses of treatment.

Consult a doctor if improvement does not occur within a few days or if the following symptoms occur: pale skin, sore throat, fever, unusual bleeding or bruising, unusual tiredness or weakness.

Monitor your blood picture regularly.

When chloramphenicol is used in patients with diabetes mellitus, false positive results may occur in tests for the presence of glucose in urine.

Table. Chloramphenicol. Main characteristics and application features

* With normal liver function

Chloramphenicol Eye Ointment is a prescription topical antibiotic prescribed to treat a number of different serious eye infections. The medicine is very effective, but serious allergic reactions and other adverse side effects may occur. Doctors reserve this ointment for cases of infection that do not respond to other less dangerous medications. Most patients who use the ointment regularly receive complete relief from the symptoms they experience.

Release form

Chloramphenicol eye ointment is available in a plastic tube with an application tip.

When is the ointment effective and when is it prescribed?

The antibiotics in chloramphenicol are effective in killing strains of staphylococci, streptococci, E. coli, and several other less common bacteria. It works by entering bacterial cells and disrupting the protein synthesis needed for bacteria to replicate their DNA, multiply and spread. Existing bacteria are eventually killed and the symptoms of irritation are relieved.

Before prescribing chloramphenicol, doctors usually try to treat infections with other antibiotics and sedative eye drops. Patients whose symptoms persist or worsen may be referred to more qualified vision specialists who can determine whether the ointment would be a good treatment option.

Dosage

The correct dosage is determined by the doctor, based on the type of bacteria involved, the patient's age and the severity of symptoms. Most adults are advised to apply about a 1/2-inch strip of ointment under their eyelids every three hours. Children usually need to use about half the recommended dose.

Instructions for use

Taking care not to touch the eye with the tip, the user pulls back their lower eyelid and squeezes out the appropriate amount of ointment. After applying, you need to close your eyes for a few seconds so that the ointment is well distributed. Patients are usually instructed to continue using the ointment until symptoms are completely absent to ensure that the infection has cleared.

Side effects

The most well-known side effects of chloramphenicol ophthalmic ointment are a mild burning or tingling sensation after use. Sometimes the ointment can temporarily worsen irritation and other eye symptoms.

A rare but serious risk when using the ointment is the development of potentially fatal blood disorders, including aplastic anemia and thrombocytopenia. The risk of getting a blood disorder is very low, but most doctors still do regular blood tests during treatment to help avoid problems.

Tradename
Monopreparations: Levomycetin (Slavic Pharmacy, Tatkhimfarmpreparaty, Lekko), Levomycetin-AKOS (Sintez), Levomycetin-DIA (Diapharm), Levomycetin-Ferrein (Bryntsalov-A). Combination drugs: Colbiocin (Zambon).

Chemical name: (-)-Chloramphenicol
Molecular formula: C 11 H 12 Cl 2 N 2 O 5
Molar mass: 323.129
CAS number: 56-75-7
Solubility: Highly soluble in ethanol, butanol, acetone and ethyl acetate. Poorly soluble in water.

Release form, composition
Levomycetin (Slavyanskaya Pharmacy, Lekko, Diapharm) – eye drops, 2.5 mg of chloramphenicol in dropper bottles of 5.0 and 10.0 ml.

Levomycetin (Tathimpharmpreparaty) – eye drops, 2.5 mg of chloramphenicol in a 5.0 ml bottle with a dropper.

Levomycetin (Synthesis) – eye drops, 2.5 mg of chloramphenicol in a bottle with a dropper or a 5.0 ml dropper bottle. Transparent slightly yellowish solution.

Levomycetin (Bryntsalov-A) - eye drops, 2.5 mg of chloramphenicol in bottles of 5.0 and 10.0 ml.

Colbiocin (see tetracycline).

Excipients
Levomycetin (Lekko), Levomycetin-AKOS – boric acid, purified water. Levomycetin-DIA – boric acid. Colbiocin (see tetracycline).

pharmachologic effect
A broad-spectrum antibiotic with primarily a bacteriostatic effect. Capable of providing a bactericidal effect against Staphylococcus aureus, Moraxella species, Salmonella spp, Shigella spp, Bacteroides fragilis, Clostridia spp (some), Rickettsia spp, Chlamydia trachomatis, Mycoplasma spp, Enterobacteriaceae, Haemophilus influenzae and Neisseria, Streptococcus pyogenes, viridians, pneumonia (some ).

The drug penetrates the bacterial cell wall and, by binding to 50S ribosomal subunits, inhibits protein synthesis.

In general, resistance to chloramphenicol develops slowly.

Pharmacokinetics
There are no data on the pharmacokinetics of the drug when administered locally. When used orally, it is quickly absorbed from the gastrointestinal tract (bioavailability 80%). In adults, 50-60% of the drug is bound to plasma proteins. Metabolized in the liver, where 90% is conjugated to an inactive glucuronide. The normal half-life is 1.5-3.5 hours. With renal and liver failure, these indicators can increase significantly. In children in the first days of life, it is 24 hours or more (especially with low body weight), at the age of 1 month to 16 years - 3-6.5 hours. It is excreted primarily by the kidneys.

Dosage regimen
1-2 drops into the affected eye up to 6 times a day. In severe cases, it can be used every 15-20 minutes with a gradual reduction in the frequency of instillations as the infectious process subsides.

Indications for use
Treatment of bacterial conjunctivitis, keratitis, blepharitis.

Contraindications
Hypersensitivity to the components of the drug.

Precautions and Warnings
Despite the low likelihood of developing aplastic anemia with topical use of chloramphenicol, this must be taken into account when prescribing it. The drug should not be prescribed to patients in whom it has previously caused bone marrow failure.

It is necessary to refrain from wearing contact lenses while using the drug.

Long-term use of chloramphenicol should be avoided, as this increases the risk of developing sensitization and resistance of microorganisms to it. It is not recommended to use it for more than 5 days. If there is no improvement in the condition within 2 days or progression of symptoms is noted, it is advisable to replace chloramphenicol with another antibacterial drug.

FDA risk category for using the drug during pregnancy is C. The safety of chloramphenicol during pregnancy and lactation has not been studied. The drug can be absorbed into the systemic circulation and penetrate the placenta into breast milk. For these reasons, its use is not recommended during pregnancy and lactation.

In experiments with mice, oral administration of chloramphenicol caused toxic reactions, including the death of premature and newborns, as well as the “gray” syndrome (abdominal bloating with and without vomiting, progressive “pale” cyanosis, vascular collapse, often accompanied by respiratory failure, death after a few hours after the onset of symptoms).

The drug may cause temporary blurred vision and eye irritation after instillation. It is necessary to refrain from driving until visual functions are completely restored.

Side effects
Transient burning, irritation, redness, lacrimation, and dermatitis are possible after instillation into the eye.

Cases of bone marrow suppression, including irreversible aplastic anemia with fatal outcome, have been reported following topical use of chloramphenicol.

Drug interactions
The combined use of chloramphenicol with oral hypoglycemic drugs may enhance their hypoglycemic effect.

Simultaneous use with drugs that inhibit bone marrow hematopoiesis (for example, sulfonamides) enhances this effect.

Prescribing the drug with erythromycin, clindamycin, lincomycin, rifampicin may weaken the effect of both drugs.

Due to the inhibitory effect of chloramphenicol on the cytochrome P450 enzyme system, combined use with phenobarbital, phenytoin, warfarin leads to a slowdown in metabolism, excretion, and increased plasma concentrations of these drugs.

The active substance is considered a synthetically produced antibiotic, which is similar to the antibacterial substances synthesized by streptomycetes. The antibacterial effect is realized due to inhibition of peptidyl transferase after binding of the substance to the ribosomal apparatus of the cell. As a result, there is a blockage of synthetic processes for the production of protein in the cell of a sensitive microorganism.

The drug has a bacteriostatic effect. The following microorganisms are sensitive to chloramphenicol: most cocci (G+, G-), Escherichia coli, Salmonella, Haemophilus influenzae, spirochetes, Shigella, anaerobic microorganisms, Rickettsia, Klebsiella, Serracia, Proteus, Yersinia.

A virulocidal result is observed against the causative agent of trachoma, inguinal lymphogranulomatosis, and psittacosis. There is sensitivity to chloramphenicol in penicillin-resistant strains of bacteria, streptomycin-resistant microorganisms, and bacteria insensitive to sulfonamides. Weak activity of the drug is observed in relation to acid-resistant bacteria in Pseudomonas aeruginosa, orders of protozoa, and clostridia. Resistance to the drug develops slowly.

Indications for use

Parenteral and oral forms of the drug Chloramphenicol are indicated for:

• typhoid fever;
• tularemia;
• pathologies associated with Yersinia;
• paratyphoid infection;
• pathologies associated with meningococci;
• dysentery infection;
• trachoma;
• urinary tract infection;
• salmonellosis;
• lymphogranuloma in the groin area;
• wound infection with purulent discharge;
• infectious pathologies associated with rickettsia;
• abscess of cerebral tissue;
• purulent peritonitis;
• chlamydia;
• ehrlichiosis;
• infectious damage to the biliary organs;
• brucellosis.

External forms of release of the drug Chloramphenicol are indicated for skin lesions caused by bacterial agents (boils, burns complicated by infection, trophic ulcers, pressure sores, cracks in the nipple area in nursing mothers).

Eye drops are indicated for the treatment of infections in ophthalmology.

Mode of application

Tablets and capsules are taken orally on an empty stomach (30 minutes before). If you have nausea or vomiting, you can take it 60 minutes after eating. Daily dosage is 2–4 g, divided into 4 doses.

The dose for children (single dose) is calculated using the following formula: 10–15 mg per kilogram of body for patients under 3 years of age. When indicated in children 3–8 years old, it is recommended to take 0.15–0.2 g per dose. For patients over 8 years of age, 0.6–1.2 g/day is prescribed. The course of therapy is 7–10 days. It is possible that the course will be extended to 14 days if the therapeutic agent is well tolerated.

Liniment and external solution are used to treat skin surfaces 2-3 times a day. It is possible to use liniment under an occlusive dressing with dressings once every 1–4 days. Use continues until the wound surface is completely cleansed.

Eye drops are used for instillation into the conjunctival sac. Instillation is carried out several times a day for a week.

Dosing of parenteral forms of the drug is carried out individually, depending on the type and severity of the pathological process.

Suppositories are administered intravaginally after the dosage form is released from the contour packaging. The injection is carried out in the supine position. It is recommended to use 2–3 suppositories/day. It is likely that girls during puberty should be prescribed 1–2 suppositories/day. Duration of therapy is 8–10 days.

Side effects

The use of the drug Chloramphenicol may be accompanied by:

• dyspeptic symptoms;
• psychomotor disorders;
• leukopenia;
• depressive states;
• urge to vomit;
• dermatitis;
• thrombocytopenia;
• attacks of nausea;
• hypohemoglobinemia;
• headache;
• hallucinations (visual, auditory);
• diarrhea;
• agranulocytosis;
• angioedema;
• cardiovascular collapse (in children under 12 months);
• hearing impairment;
• irritation of the oral mucosa;
• visual impairment;
• change in consciousness;
• aplastic anemia;
• delirium;
• dysbacteriosis;
• skin rash;
• changes in taste perception;
• hives;
• the addition of a fungal infection;
• optic neuritis;
• itchy skin;
• hyperemia of the skin.

Contraindications

Chloramphenicol is not prescribed for:

• hypersensitivity to chloramphenicol;
• psoriasis;
• intermittent porphyria in acute form;
• eczema;
• hypersensitivity to additive components of the prescribed dosage form;
• skin pathologies associated with fungal infection;
• kidney pathologies with severe impairment of their functions;
• pathologies of the hematopoietic organs;
• indications in the neonatal period;
• severe liver pathologies;
• indications in early childhood;
• G6PD deficiency;
• lactation (for oral, parenteral forms of the drug).

Caution is required when prescribing Chloramphenicol for:

• pathologies of the cardiovascular system;
• tendency to develop allergic reactions.

Pregnancy

The use of the drug Chloramphenicol in pregnant patients is possible in the absence of a safer alternative and there is a potentially significant benefit from the drug that outweighs the possible risk to the developing fetus.

Interaction with other drugs

Overdose

When using external forms of the medicine, eye drops, the risk of overdose is minimal. When therapeutic doses of chloramphenicol are exceeded, cardiovascular syndrome develops. It is especially often observed in patients in the neonatal and early childhood period.

Large dosages of chloramphenicol provoke a negative effect on the myocardium with the appearance of a gray tint of the skin, hypothermia, respiratory failure, and myocardial failure. Mortality during the development of this syndrome reaches 40%. Carrying out hemosorption measures and prescribing therapy appropriate to the symptoms are indicated.

Release form

Chloramphenicol is available in the form of eye drops, suppositories, alcohol solution, tablets, capsules, liniment. The packaging of the medicine is as follows:

– 10 tablets/paper packaging;

– 5 ml drops/glass bottle+dropper cap/packaging;

– 10 ml drops/glass bottle+dropper cap/packaging;

– 20 tablets/cardboard packaging;

– 20 capsules/cardboard package;

– 25 ml of solution/glass bottle;

– 0.5 g powder/glass bottle/packaging;

– 1 g powder/glass bottle/packaging;

– 25 g liniment/tube/packaging;

– 10 suppositories/pack.

Storage conditions

The storage temperature of tablets is up to 25 degrees Celsius. The shelf life of the tablet form is 3 years. The alcohol solution should be stored at a temperature of 8–15 degrees Celsius for no more than 1 year.

Chloramphenicol eye drops are suitable for use for 2 years if stored at a temperature of 8–15 degrees Celsius. The powder in bottles should be stored at a temperature of 15–25 degrees Celsius for no more than 4 years.

Chloramphenicol capsules are suitable for use for 5 years at storage temperatures up to 25 degrees Celsius. Liniment should be stored at a temperature of 15–25 degrees for no more than 2 years.

Synonyms

Levomycetin-LekT, Berlitsetin, Levomycetin, Levomycetin-BHFZ, Levomycetin-Darnitsa, Levomycetin succinate, Syntomycin, Chloramphenicol Levo, Chlorsin, Levomycetin-Ferein, Levomycetin-AKOS, Levomycetin-KMP, Detreomycin, Levomycetin-UBF, Levomycetin-DIA, Levom icetin- Acri, Levovinisol, Levomycetin Actitab, Amphoben, Levamycin, Euchlor, Chlorotsid-G.

Compound

1 Chloramphenicol suppository contains 250 mg of chloramphenicol. Additive component: vitepsol.

1 ml of Chloramphenicol eye drops contains 25 mg of chloramphenicol. Additive components: boric acid, prepared water.

1 g of liniment Chloramphenicol 5% contains 0.05 g of chloramphenicol. Additive components: emulsifier, castor oil, sodium carmellose, sorbic acid, prepared water.

1 g of liniment Chloramphenicol 10% contains 0.1 g of chloramphenicol. Additive components: emulsifier, castor oil, sodium carmellose, sorbic acid, prepared water.

1 bottle of Chloramphenicol powder 1 g contains chloramphenicol sodium salt (sterilized) 1000 mg (in terms of chloramphenicol).

1 bottle of Chloramphenicol powder 500 mg contains chloramphenicol sodium salt (sterilized) 500 mg (in terms of chloramphenicol).

1 tablet Chloramphenicol 250 mg contains chloramphenicol 0.25 g. Additive components: calcium stearate, starch.

1 tablet Chloramphenicol 0.5 g contains chloramphenicol 250 mg. Additive components: stearic acid, starch.

1 capsule of Chloramphenicol contains chloramphenicol 0.25 g.