----- Original Message -----
From: Roger White <[log in to unmask]>
Date: Thursday, April 22, 2004 0:50 am
Subject: [BEE-L] China

> Keith Benson wrote:
> ''So, it is reserved for susceptible infections in weird places
> that are poorly treated with other things ''
> This is just not correct - it is used as an opthalmic antibiotic
> in Europe.

The fact that it available and used is not at odds with what I have stated.  Most ophthalmologists I know would reserve use of the drug for particular cases and rely on other preparations for routine use because of some of the perceived risks involved, and because there are often more effective meds out there for most ocular infections.  In effect they “reserve” it.  Please also bear in mind that my comments were largely directed towards systemic preparations.  My apologies for not being absolutely clear.

The use of Chloramphenicol has dropped off considerably in recent years since the association with Aplastic Anemia was made and most physicians and veterinarians will opt for something else when possible.  Doesn't mean the stuff is not still manufactured or used.  IT clearly has its place in the medical armamentarium.

I won’t get into a lengthy discussion of how and why the material may or may not be indicated in every possible scenario – suffice it to say that it is not commonly used (like penicillins, cephalosporins and flouroquinolones) and most facilities do reserve its use for cases where there is a susceptible infection, that is poorly treated with other meds.  In such instances there are often other drugs that might kill the bacterium in question – but something prevents delivery to a particular tissue (e.g. blood prostate barrier, blood aqueous barrier etc.)  In otheres the bug is resistant to mot everything else.

Individual physicians and veterinarians do this themselves as well – often in self defense.  Perhaps in NA some are reluctant to use it as this is a fairly litigious society.  I know veterinarians that will not dispense it to pet owners so as to avoid the liability that may come with exposing a pet owner to the stuff.  Overkill perhaps, but certainly true.  I know pediatricians that will no longer use it for uncoomplicated respiratory infections (It was once marketed as a tasty syrup for just that purpose) as there are safer materials available.  How do I know this?  I have discussed it with them directly.

>  Hardly life threatening and certainly not a situation
> that cannot be treated with other antibiotics.

The text you quoted above does not mention life threatening.  There are occasionally infections in tissues where chlormaphenicol is the drug of choice - and it is used at those times.  There are also strains of bacteria against whom the only viable choice is chlormaphenicol.  Remember, simple sensitivity is not the only reason one might pick a drug.  Again, not at odds with what I wrote.

BTW - how often is it used in Europe compared to other preparations?  Is it commonly used as a first line drug for an uncomplicated eye infection?  Or is it reserved for resistant infections, melting corneal ulcers etc?

Loss of vision, while not life threatening is often life changing – and considered serious business.  This affects clinical choices.  I would be more apt to reach for the stuff to treat a serious ophthalmic infection than perhaps an infected hangnail.  There is a difference.

>  I thought that it
> was a banned substance in Europe - but apparently it can get
> lincensed for medical use.

Banned for use in *food animals*.  It is still available and can be used in humans, pet species and other non-food animals.  I have several bottles of the stuff on my shelves as we speak.  I would not hesitate to use it if I thought it warranted, as aplastic anemia is not associated with the use of this drug in veterinary medicine.  Heck, even if AA was associated with chlormaphenicol in animals there are still many instances where I would use the stuff – but not willy nilly.

Short version, chlormaphenicol is reserved by most physicians and veterinarians for cases where it is clearly required over other preparations for a variety of circumstances.  It is, of course, available – how else would we use them in those aforementioned circumstances?

OB Beekeeping:  It should not find its way into honey.

Cheers,

Keith

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