Chloramphenicol Toxicity Revisited: A 12-Year-Old Patient With a Brain Abscess

Wiest, Donald B.; Cochran, Joel B.; Tecklenburg, Fred W.

doi:10.5863/1551-6776-17.2.182

Cited by 43 publications

(48 citation statements)

References 38 publications

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“…Adequate controlled clinical trials in children, with the notable exceptions of pediatric oncology and vaccinations, are insufficient due to ethical considerations. Only a vigilant post marketing surveillance detects ADRs occurring uniquely in children, for example, sulfonamide induced Kernicterus in premature infants, 3 Chloramphenicol induced "Grey baby syndrome" 4 and Phenytoin induced movement disorders. 5 Certain conditions in children in general, and in Indian children in particular, highlight the need for ADR monitoring.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Adverse Drug Reactions in 1 Month–12 Years Old Pediatric Patients

Raut

Kalrao

Rani

et al. 2015

Indones J Clin Pharm

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Adequate controlled clinical trials in pediatric population, especially in oncology and vaccinations are still insufficient due to ethical considerations. Certain conditions in children in general and in Indian children in particular, suggested the need for Adverse Drug Reaction (ADR) monitoring. Thus this study was aimed to investigate the incidence of ADRs in pediatric populations. A prospective spontaneous reporting study was conducted over a period of six months from October 2012 to March 2013 in pediatric inpatients ward of Bharati Hospital in Pune. Reported ADRs were assessed for its causality by using WHO causality assessment scale, and its severity by using Hart wig Severity Scale. A total of 107 suspected ADRs were reported and evaluated from 54 patients, showing an overall incidence of 4.75%. Incidence rate of ADRs during hospitalization was 4.13%, while ADRs induced hospitalization was 0.62%. The gastrointestinal system (48.59%) was the most affected, and antibiotics was the most common the drug class associated to ADRs. In term of causality, 55.14% of the reactions were classified as possible, while in term of severity, 64.49% were classified as moderate. Most patients (60.75%) recovered from the incidence. Although the prevalence and severity of ADRs in pediatrics populations is reported to be higher than those of in adults, the incidence of ADRs in our study was only 4.75% which is lower than those of reported in adults, this may due to the spontaneous reporting system that used in this study. AbstrakUji klinik pada anak khususnya onkologi dan vaksinasi masih kurang memadai karena pertimbangan aspek etik. Kondisi tertentu pada anak secara umum dan khususnya di India memerlukan pemantauan Rekasi Obat yang Merugikan (ROM). Penelitian ini bertujuan untuk mengetahui insidensi ROM pada pasien anak. Studi pelaporan spontan prospektif dilakukan selama enam bulan pada Oktober 2012-Maret 2013 di bangsal anak Rumah Sakit Bharati di Pune. ROM yang dilaporkan dinilai kausalitasnya dengan WHO causality assessment dan keparahan dengan skala Wig Hart Severity. Sebanyak 107 suspek ROM dilaporkan dan dievaluasi dari 54 pasien menunjukkan insidensi sebesar 4,75%. Tingkat kejadian ROM selama rawat inap sebesar 4,13% sementara ROM yang menyebabkan pasien dirawat inap sebesar 0,61%. Sistem pencernaan (48,5%) paling sering dilaporkan dan antibiotik sebagai obat yang berasosiasi dengan ROM. Berdasarkan kausalitas, 55,14% reaksi obat diklasifikasikan possible (55,14%) sementara dalam aspek kepaharahan, 64,49% diklasifikasikan moderat. Mayoritas pasien sembuh dari ROM (60,75%). Prevalensi dan keparahan ROM pada anak dilaporkan lebih tinggi dibandingkan dewasa, akan tetapi insiden ROM pada penelitian ini hanya 4,75% yang lebih rendah daripada yang dilaporkan pada orang dewasa, dimungkinkan karena penelitian ini merupakan sistem pelaporan spontan.Kata kunci: Causality, keparahan, reaksi obat yang merugikan, sistem pelaporan spontan prospektif Research Article

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Section: Introductionmentioning

confidence: 99%

A Prospective Study of Adverse Drug Reactions in 1 Month–12 Years Old Pediatric Patients

Raut

Kalrao

Rani

et al. 2015

Indones J Clin Pharm

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“…The most common manifestation is optic neuritis, but peripheral neuropathy can occur. The latter is typically associated with extended use of the drug in people, but the exact mechanism of neurotoxicity is not currently known (Thomas 1994, Wiest and others 2012). Peripheral neuropathy associated with chloramphenicol has been reported anecdotally in animals and may be the cause of weakness in the current study; however, the dogs were not examined by a neurologist for a definitive diagnosis (Bryan and others 2012, Frank and Loeffler 2012).…”

Section: Discussionmentioning

confidence: 99%

Adverse events associated with chloramphenicol use in dogs: a retrospective study (2007–2013)

Short¹,

Zabel

Cook³

et al. 2014

Veterinary Record

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Chloramphenicol is a broad spectrum antibiotic that has been increasingly utilised since the emergence of methicillin-resistant staphylococcal infections. Due to toxicities in humans, use of the drug has been limited. In dogs, gastrointestinal signs are common adverse events described, and bone marrow suppression is possible. The aim of this study was to evaluate the adverse events associated with chloramphenicol in dogs seen by one specialty practice from January 2007 through June 2013. The database was searched for all dogs prescribed chloramphenicol during the time period. Dosage, length of treatment, age and body weight of the dogs were recorded as well as any adverse events that occurred during treatment. A total of 105 cases were evaluated. Thirty-nine dogs experienced at least one adverse event while on the medication. The most commonly noted were gastrointestinal signs and hindlimb weakness. The mean body weight for dogs with hindlimb weakness was 35.3 kg, which was significant. Resolution was documented in 54 per cent of cases when the drug was discontinued. Methicillin-resistant Staphylococcus pseudintermedius on bacterial culture was listed as the reason for chloramphenicol use in 76 per cent of the cases. Based on this information, further prospective studies are recommended to evaluate the reproducibility of this report.

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“…1 Associated toxicities include grey baby syndrome and medullary aplasia. [1][2][3] This toxicity profile likely results from the inhibition of mitochondrial protein synthesis, which leads to respiratory chain protein insufficiency and eventual oxidative phosphorylation dysfunction. [2][3][4][5][6] This toxic phenomenon can result in hyperlactatemia and associated metabolic acidosis.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] This toxicity profile likely results from the inhibition of mitochondrial protein synthesis, which leads to respiratory chain protein insufficiency and eventual oxidative phosphorylation dysfunction. [2][3][4][5][6] This toxic phenomenon can result in hyperlactatemia and associated metabolic acidosis. [2][3][4][5][6] Inhibition of mitochondrial protein synthesis with lactic acidosis, medullar toxicity and peripheral neuropathy has been previously reported with linezolid, which shares pharmacological properties with chloramphenicol.…”

Section: Introductionmentioning

confidence: 99%

Lactic Acidosis with Chloramphenicol Treatment in a Child with Cystic Fibrosis

Goyer

Iseppon

Thibault

et al. 2017

JPTCP

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Children with cystic fibrosis are commonly colonized with multi-resistant bacteria. In such patients, infectious exacerbation may require salvage therapy with uncommonly used antimicrobials, including chloramphenicol. Chloramphenicol is rarely used nowadays because of the associated severe adverse events. We describe the case of a 15-year-old female with terminal cystic fibrosis who required intravenous (IV) chloramphenicol treatment for a Burkholderia cepacia (B. cepacia) exacerbation. The child subsequently developed lactic acidosis and secondary respiratory compensation adding to her baseline respiratory distress. Based on the Naranjo scale, the probability of chloramphenicol being the cause of the hyperlactatemia and associated respiratory distress was rated as probable, as the adverse effects resolved upon discontinuation of the drug. Subsequent genotyping for mitochondrial polymorphism (G3010A) confirmed a possible susceptibility to lactic acidosis from mitochondrial RNA-inhibiting agents such as chloramphenicol. Hyperlactatemia is a rare but life threatening adverse effect that has been previously reported with chloramphenicol exposure, but is not generally thought of. Clinicians should be aware of this potentially life threatening, but reversible adverse event. Lactate should be monitored under chloramphenicol and it should be discontinued as soon as this complication is suspected, especially in patients with low respiratory reserve.

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Chloramphenicol Toxicity Revisited: A 12-Year-Old Patient With a Brain Abscess

Cited by 43 publications

References 38 publications

A Prospective Study of Adverse Drug Reactions in 1 Month–12 Years Old Pediatric Patients

A Prospective Study of Adverse Drug Reactions in 1 Month–12 Years Old Pediatric Patients

Adverse events associated with chloramphenicol use in dogs: a retrospective study (2007–2013)

Lactic Acidosis with Chloramphenicol Treatment in a Child with Cystic Fibrosis

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