I remember them smartypants guys in school (uh…‘profs’ or something) saying that chloramphenicol, while very effective, may cause aplastic anemia in something 1/10,000 patients. My friend was just prescribed chloramphenicol eye drops, and I understand that hospitals have on hand to treat serious infections when nothing else will work. Is it wise to be prescibing chloramphenicol eye drops w/o a culture and sensitivity? When would they give a patient IV or tab chloramphenicol, and how routinely is this done?
I’ve practiced medicine for over 2 decades, and I have never prescribed it.
Not to contradict the sagacious QtM, but it’s still sometimes used in eye drops (especially outside of the USA) and I have done so myself. AFAIK, the hematologic side effects occur almost exclusively from oral or intravenous administration of the drug. Aplastic anemia from ocular use alone is exceedingly rare.Here is an (old) reference.
I got a shudder when I visited a Mexican pharmacy and saw chloramphenicol tablets available freely, without a prescription.
So enlighten us curious non-medical types…
What’s aplastic anemia?
Is 1/10,000 bad odds in general for side effects for any medication, or is aplastic anemia so dangerous that you can’t take the chance at all except as a last resort?
Or is this more of a case where there’s a more effective drug anyway, with better results and less toxicity?
Thanks!
I know! I know!
Aplastic Anemia[sup]1[/sup] is a condition where in the bone marrow ceases to manufacture blood cells, in all three cell lines. (Red, white and platelets.) (Aplastic anemia[sup]2[/sup] Aplastic Anemia [sup]3[/sup] (the three sites are progressivly more sophisticated, to cover everyone)
The loss of red cells causes tiredness, due to the lower oxygen carrying capacity of the blood with fewer transport cells available. Eventually enough red cells would die off and not be replaced, to cause hypovolemic shock and death.
White blood cells are the ones that protect us from infection. without them infection from one’s own flora is certain. Antibiotics are less effective, pretty soon the body goes into septic shock and dies.
Platelets are part of the very complicated clotting cascade, a series of chemicals and colllegen that form clots.
Any gaps in the cascade and the wheels fall off. If platelets are missing, bleeding will occur in any number of inopportune places, like the brain,causing neuro shock and death, or the lungs causing profound hypoxemia and death.
See a trend here?
There are many causes, some of which we haven’t actually discovered. When a causative agent can’t be identified, we call it idiopathic aplastic anemia.
In the luckiest cases, withdrawal of the causative agent will allow the factories to reopen.
Unfortunately, that sort is rare. The only long term treatment or cure, is a successful bone marrow transplant.
In cases where the agent isn’t know, there’s a high probablity that whatever attacked the original marrow is still present and will either prevent the new marrow from seeding, or will shut down the new marrow soon.
Ok, you ask, why can’t I just have transfusions… Issues of banked/preserved blood aside, there are more components in the blood than we have available for transfusion. Not to mention, there aren’t enough donors to keep one alive for more than a few days.
Now, we’ve done bone marrow transplantation before, should I go over it again? It won’t be on the test 
Who told you about my sagassiousness?? :eek: I’m working harder on the diet and exercise, I really am!! I hope to reduce the unfortunate tendancy towards sagassity soon!
Anyway, what everybody else said.
I certainly didn’t want to imply that chloramphenicol is never used, only that I’ve never used it.
Sagassioussnesssses? At least he didn’t make fun of your preciousssss. I’ve prescribed chloramphenicol twice in patients “allergic” to most other things.
I’ve always suspected a sagacious tendency in you, and even your daughter. I’m sure some agency from the first half of the alphabet is surveiling you and yours.:dubious: In my nearly 40 years, I’ve given it twice. Once, as a corpsman in the Air Force. Given to a 4 yr old who did develop aplastic anemia and ultimately died.
The other was a septic patient who had run through all other even margininally sensitive antibiotics. By the time he got the chloramphenicol, he was deep into septic shock and sliding into multi-system failure, so there wasn’t much choice. (No, he didn’t resopnd. He died the next day.)