Chloramphenicol is primarily bacteriostatic. It binds to the 50S subunit of the ribosome, thereby inhibiting protein synthesis. Pharmacology Chloramphenicol is well absorbed after oral administration. Parenteral therapy should be administered intravenously. Chloramphenicol has a large volume of distribution in the body fluids, including cerebrospinal fluid, and is excreted renally. Because of the hepatic metabolism and chloramphenicol does not accumulate in renal failure. Indications Chloramphenicol has a broad spectrum of activity against Gram-positive and Gram-negative cocci and bacilli (including anaerobes) Rickettsia, Mycoplasma, Chlamydia and Chlamydophila spp. Because of its bone marrow toxicity, the availability of alternative antibiotics and the occurrence of resistance Chloramphenicol is not an antibiotic of choice more for any infections with the exception of Fatal infections due to some multidrug-resistant bacteria, which remain vulnerable to these antibiotics However chloramphenicol was used to meningitis caused by penicillin-resistant pneumococci was caused relatively to treat, the results are disappointing, probably because chloramphenicol is poor bactericidal activity against these strains. Contraindications Chloramphenicol is contraindicated if a different drug may be used instead. Use during pregnancy and lactation The use of chloramphenicol during pregnancy leads to fetal exposure levels that are almost as high as the levels of the parent. Prenatal “Gray baby syndrome” is a theoretical scenario, but there is no clear evidence of fetal risk. Chloramphenicol is excreted in breast milk. The safety during breast-feeding is not yet determined. Side effects Side effects include bone marrow depression (the most severe) nausea, vomiting and diarrhea Gray baby syndrome (in neonates) There are two types of bone marrow depression: A Reversible dose-dependent interaction with the iron metabolism: This effect is most likely at high doses, by prolonged treatment or in patients with severe liver disease. An irreversible idiosyncratic aplastic anemia This anemia occurs in <1: 25,000 patients treated. This will only develop after treatment. Chloramphenicol should not be administered topically since it may lead to absorption of small amounts, thereby sometimes a aplastic anemia is caused. Hypersensitivity reactions are rare. With prolonged administration may lead to optic neuritis and peripheral neuritis. The neonatal "gray baby syndrome", belonging to the hypothermia, cyanosis, flaccidity and circulatory collapse often runs, deadly. This is due to the high serum levels, which occurs because the immature liver can not metabolize and excrete chloramphenicol. To avoid the syndrome, doctors infants ? 1 month should not give> 25 mg / kg / day as the initial dose and the dose must be adjusted to the serum levels.