To      :  Judy Canahuati
Re      :  Chloramphenicol

I know that there is great concern about chloramphenicol(Chloromycetin) in the
US. It is commonly used in other countries primarily because it is very cheap
and to be quite honest,  it is a supurb antibiotic with many unique attributes.

To begin with,  chloramphenicol has and still is associated with the "Grey Baby
Syndrome",  a syndrome in which the plasma level of chloramphenicol rises too
high in young infants, simply because they have immature metabolic systems and
cannot handle the dose provided.  This system is associated with severe bone
marrow toxicity and if untreated, has a high mortality.  But again,  it is
primarily associated with elevated plasma levels.  In the US,  we still
sometimes use chloramphenicol in children with close monitoring and it can be
life saving.  I expect that in the next decade we may even go back to it more
to treat certain resistant bacterial species that are increasingly evident. But
the one major condition for using chloro is to monitor the blood level and keep
it below 20 ug/ml.

Secondly,  chloramphenicol is also associated with an aplastic anemia, which is
autoimmune associated and seems to occur in about 1 of 42,000 patients.  This
is very rare and is seldom seen.  However,  75% of these cases have had a
"previous" exposure to the antibiotic.  I'm a little worried that breastfeeding
while the mom takes chloro may provide this "previous" exposure and may
increase the incidence in these children.

In the hands of a skilled clinician,  chloramphenicol is a pretty wonderful
antibiotic and we should not get too upset about its occassional use by
infectious disease docs who know how to use it.

As to the question of alternatives,  there are really many antibiotics
available, from the cephalosporins to the tetracyclines and erythromycins that
have similar spectrums and offer a suitable alternative in most cases.  But
there are some times,  when severely resistant bugs require this old warrior,
and in at least two occassions, I've seen it save childrens' lives.

So everything seems to have its place,  and chloramphenicol has its as well, we
just don't call upon it too often.


Best Regards
Tom Hale