Chloramphenicol

INTRODUCTION

Indications

IV: Management of the following serious infections when less toxic agents cannot be used: Skin and soft-tissue infections, Intra-abdominal infections, CNS infections (including meningitis), Bacteremia. Ophth: Management of local infections.

Action

Inhibits protein synthesis in susceptible bacteria at the level of the 50S ribosome. Therapeutic Effects: Bacteriostatic action. Spectrum: Wide variety of gram-positive aerobic organisms, including Streptococcus pneumoniae and other streptococci, Some enterococci (especially vancomycin-resistant). gram-negative pathogens: Haemophilus influenzae, Neisseria meningitidis, Salmonella, Shigella. Anaerobes: Bacteroides fragilis, Prevotella melaninogenica. Other organisms inhibited: Rickettsia, Chlamydia, Mycoplasma.

Adverse Reactions/Side Effects

CNS: confusion, delirium, depression, headache. EENT: blurred vision, optic neuritis. GI: bitter taste (IV only), diarrhea, enterocolitis, glossitis, nausea, stomatitis, vomiting. Derm: rashes, urticaria. Hemat: APLASTIC ANEMIA, bone marrow depression, neutropenia, thrombocytopenia. Neuro: peripheral neuritis. Misc: ANGIOEDEMA, GRAY SYNDROME IN NEWBORNS, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of aplastic anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Monitor signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician immediately of these signs.

• Monitor newborns for signs of gray syndrome (also called chloramphenicol toxicity in newborns), including gray/ashen skin color, cyanosis, respiratory distress, hypotension, vomiting, and hypothermia. Report these signs immediately to the physician or nursing staff.

• Report signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), and fatigue that might be due to bone marrow depression or other blood dyscrasias.

• Be alert for signs of peripheral neuritis (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Monitor signs of CNS toxicity, including confusion, delirium, depression, and headache. Report these signs to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient to report any signs of optic neuritis such as blurred vision or other vision disturbances.

• Advise patient about the likelihood of GI reactions, including nausea, vomiting, diarrhea, abdominal pain, inflammation in/around the mouth, and taste abnormalities. Instruct patient to report severe or prolonged GI problems.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever or skin problems (rash, hives).

Pharmacokinetics

Absorption: Some systemic and intraocular absorption follows ...