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Chloramphenicol

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VOL: 100, ISSUE: 48, PAGE NO: 33

- Capsules: chloramphenicol....

GENERIC/PROPRIETARY NAMES

- Capsules: chloramphenicol.

- IV injection: Kemicetine, Chloromycetin.

- Eye: chloramphenicol, Chloromycetin, Minims Chloramphenicol.

- Ear: chloramphenicol.

- Topical: Actinac.

CLASSIFICATION

- Functional: broad-spectrum antibiotic.

- Chemical: dichloroacetic acid derivative.

- Legal: prescription only.

ACTION

- Interferes with protein synthesis in intact bacterial cells.

INDICATIONS

- Nurse prescriber: ophthalmic infections.

- Other: otitis externa; acne, rosacea (topical); severe infections (oral/IV); all preparations are active against a wide range of organisms including Salmonella typhi, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, Mycoplasma spp, Chlamydia spp.

CONTRAINDICATIONS

- All routes: hypersensitivity.

- Ear: perforated eardrum.

- IV: during labour.

- Oral/IV: previous toxic reaction, pregnancy, breastfeeding, porphyria, trivial infections.

CAUTIONS

- Ear: avoid prolonged use, high incidence of hypersensitivity reactions.

- Eye: overgrowth of non-susceptible organisms.

- Oral/IV: reduce dose in impaired hepatic/renal function, overgrowth of non-susceptible organisms, carry out blood studies.

- Topical: pregnancy.

SIDE-EFFECTS/ADVERSE REACTIONS

- Ear: irritation, itching, rash, urticaria, contact dermatitis, burning.

- Eye: transient stinging/burning sensations.

- Oral/IV: blood disorders including aplastic/hypoplastic anaemia, bone marrow depression, peripheral/optic neuritis, erythema multiforme, nausea, vomiting, diarrhoea, stomatitis, glossitis, Grey's syndrome in newborn.

- Topical: severe erythema.

INTERACTIONS (ORAL/IV)

- Enhanced effects of acenocoumarol, warfarin, tolbutamide, phenytoin.

- Reduced effects of chloramphenicol with rifampicin, phenobarbitone.

- Half-life prolonged by paracetamol.

- Avoid myelosuppressive drugs.

ADMINISTRATION

- Ear: clean stopper and warm solution to body temperature.

- Eye: wash hands and cleanse eye before application, apply pressure to lacrymal sac for one minute to prevent systemic absorption. Apply topically inside lower eye lid.

- IV: injection over at least one minute as a solution containing 25mg/ml or 100mg/ml; infusion after further dilution in suitable quantity of fluid.

- Oral: on empty stomach with full glass of water.

NURSING CONSIDERATIONS

- Ear: evaluate therapeutic response. Redness, swelling, pain in the ear indicates superimposed infection.

- Eye: evaluate therapeutic response. Itching, lacrimation, redness, swelling indicates allergy.

- IV/oral: assess allergies before treatment. Mark in bright red on chart. Alert all people giving medication. Monitor fluid balance, bowel patterns. Evaluate therapeutic response - decreased temperature, negative culture.

PATIENT TEACHING

- Ear: method of instillation using aseptic technique. Dizziness may occur after instillation, be aware of possible side-effects, avoid prolonged use.

- Eye: use as prescribed, do not touch container tip to eye, use separate tip for each eye, wash hands between applications, do not use make-up, towels, face cloths of others; may cause blurred vision when applied; report itching, increased redness, stinging, swelling and discontinue use.

- IV/oral: complete entire course; report sore throat, fever, unusual bleeding or bruising, diarrhoea; take at equal intervals around the clock; wear/carry identification if allergic to this drug; be aware of side-effects.

- Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines.

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