Professional view

chloramphenicol: prescribing and clinical use

Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.

chloramphenicol: clinical details

Prescribing considerations

Confirm a bacterial indication and assess eye red flags before recommending topical treatment.
Reserve systemic chloramphenicol for serious infection when suitable alternatives will not suffice.
Avoid prolonged or repeated topical exposure because of sensitisation, resistant-organism overgrowth and rare haematological toxicity.
Consider hepatic or renal function, age and interacting medicines during systemic treatment.

Contraindications and cautions

Hypersensitivity to chloramphenicol or formulation excipients.
Previous chloramphenicol-associated myelosuppression or a personal or family history of blood dyscrasia, including aplastic anaemia, for selected topical products.
Perforated tympanic membrane for the selected ear drops.
For the selected capsules: minor infections, prophylaxis, active immunisation, porphyria, pregnancy, labour, breastfeeding and concurrent bone-marrow-suppressing medicines.

Monitoring

Systemic treatment requires careful clinical supervision, periodic full blood counts and discontinuation if significant haematological deterioration occurs.
Monitor chloramphenicol concentrations where indicated, particularly with hepatic or renal impairment, older age or interacting medicines.
If topical treatment is prolonged, repeated or intermittent despite usual restrictions, consider baseline and interval blood counts.

Clinical pharmacology

Chloramphenicol inhibits bacterial ribosomal protein synthesis and is usually bacteriostatic. Oral chloramphenicol is widely distributed, including into cerebrospinal fluid, crosses the placenta, enters breast milk and is mainly inactivated by the liver before urinary excretion.

Formulation and product differences

Selected eye drops are an aqueous solution requiring refrigerated, light-protected storage.
Eye ointment has a paraffin base, remains on the ocular surface longer and is more likely to cause temporary visual blurring.
Selected ear drops use propylene glycol, require refrigerated storage and must not be used with a perforated eardrum.
Capsules produce systemic exposure and carry substantially greater interaction, monitoring and toxicity considerations than topical preparations.

Chloramphenicol 5% w/v Ear Drops — Current selected SmPC Chloramphenicol 0.5% w/v Antibiotic Eye Drops — Current selected SmPC Chloramphenicol Capsules BP 250 mg — Current selected SmPC Chloramphenicol 1.0% w/w Antibiotic Eye Ointment — Current selected SmPC

chloramphenicol preparations and strengths

Eye drops

Route: Ophthalmic

Strengths: 5 mg/mL, 0.5%, 0.5% w/v, 0.5% w/w

Chloramphenicol 0.5% w/v Antibiotic Eye Drops — Current selected SmPC Eykappo (Chloramphenicol) 5mg/ml Eye Drops — Current selected SmPC Brolene Antibiotic 0.5%w/w Eye Drops — Current selected SmPC Minims Chloramphenicol 0.5%, Eye drops solution — Current selected SmPC

Eye ointment

Route: Ophthalmic

Strengths: 1.0% w/w, 1% w/w

Chloramphenicol 1.0% w/w Antibiotic Eye Ointment — Current selected SmPC

chloramphenicol interactions

Systemic chloramphenicol has clinically important interactions; topical products can still be absorbed in small amounts.

Bone-marrow-suppressing medicines

Avoid combining them because effects on blood-cell production may be additive. Examples include cytotoxic medicines, clozapine, carbamazepine and some immunosuppressants.

Chloramphenicol Capsules BP 250 mg — Current selected SmPC NHS