The potentially fatal nature of chloramphenicol-induced bone marrow suppression restricts its use to a few life-threatening infections in which the benefits outweigh the risks. There is no justification for its use in treating minor infections.
Chloramphenicol is no longer recognized as the treatment of choice for any bacterial infection. In almost all instances, other effective antimicrobial agents are available. Since effective CSF levels are obtained, it used to be a choice for treatment of specific bacterial causes of meningitis: Haemophilus influenzae, Neisseria meningitidis, and S. pneumoniae. Additionally, it was effective against H. influenzae-related arthritis, osteomyelitis, and epiglottitis. The development of p-lactamase-producing strains of H. influenzae increased the use of chloram-phenicol. However, with the advent of third-generation cephalosporins such as ceftriaxone and cefotaxime, chlo-ramphenicol use has significantly decreased. If the patient is hypersensitive to p-lactams, chloramphenicol administration is appropriate therapy for meningitis caused by N. meningitidis and S. pneumoniae.
Chloramphenicol remains a major treatment of typhoid and paratyphoid fever in developing countries. However, with increasing resistance to ampicillin, tri-methoprim-sulfamethoxazole and, to some extent, chlo-ramphenicol, fluoroquinolones and some third-generation cephalosporins (e.g., ceftriaxone) have become the drugs of choice. Salmonella infections, such as osteomyelitis, meningitis and septicemia, have also been indications for chloramphenicol use. Nevertheless, antibiotic resistance patterns can be a problem. As noted previously, nonty-phoidal salmonella enteritis is not benefited by treatment with chloramphenicol or other antibiotics.
Chloramphenicol also is widely used for the topical treatment of eye infections. It is a very effective agent because of its extremely broad spectrum of activity and its ability to penetrate ocular tissue. The availability of safer, less irritating instilled ophthalmic antibiotics and the increase in fatal aplastic anemia associated with the use of this dosage form suggest that this agent might best be withdrawn.
Chloramphenicol is an alternative to tetracycline for rickettsial diseases, especially in children younger than
8 years, and alone or in combination with other antibiotics, it has been used to treat vancomycin-resistant en-terococci. Another indication for chloramphenicol is in the treatment of serious anaerobic infections caused by penicillin-resistant bacteria, such as B. fragilis. Clindamycin and metronidazole are now preferred for treatment of anaerobic infections. Chloramphenicol, in combination with surgical drainage, is useful in treating cerebral abscesses caused by anaerobic bacteria, particularly those that are resistant to penicillin.
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