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Chloramphenicol, also known by its brand name Chloromycetin, is a broad-spectrum antibiotic that has been in use for decades due to its potent antibacterial properties. It belongs to the family of amphenicols and is primarily used to treat serious infections caused by bacteria that are resistant to other antibiotics.The mechanism of action involves inhibiting bacterial protein synthesis by binding to the 50S subunit of the ribosomal complex, thus preventing the bacteria from growing and multiplying. This makes it effective against a wide range of Gram-positive and Gram-negative bacteria, including some strains that are resistant to penicillin and tetracycline.
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| Chemical Formula | C11H12Cl2N2O5 |
| Exact Mass | 322.01 |
| Molecular Weight | 323.13 |
| m/z | 322.01 (100.0%), 324.01 (63.9%), 323.02 (11.9%), 326.01 (10.2%), 325.01 (7.6%), 327.01 (1.2%), 324.02 (1.0%) |
| Elemental Analysis | C, 40.89; H, 3.74; Cl, 21.94; N, 8.67; O, 24.76 |
Antibacterial Therapy
Chloramphenicol primarily enters bacterial cells and binds to bacterial ribosomes, impeding the growth and formation of peptide chains, thereby halting protein synthesis. Specifically, it blocks the peptidyl transferase of the 50S subunit of bacterial ribosomes, inhibiting translation and, at high concentrations, inhibiting the synthesis of eukaryotic DNA.
It is a broad-spectrum antibiotic that is particularly effective against Gram-negative bacteria. Sensitive bacteria include Enterobacteriaceae bacteria (such as Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Salmonella, etc.), as well as Bacillus anthracis, Streptococcus pneumoniae, Streptococcus, Listeria, Staphylococcus, etc. Additionally, it is also effective against Chlamydia, Leptospira, Rickettsia, and certain anaerobic bacteria such as Clostridium tetani, Clostridium perfringens, Actinomyces, Lactobacillus, and Fusobacterium.
However, despite its effectiveness, the use is restricted due to potential serious side effects. These can include bone marrow suppression, which may lead to anemia, thrombocytopenia, and leukopenia, as well as potentially fatal aplastic anemia. Additionally, it can cause gray baby syndrome in newborns, a condition characterized by gray skin color, weak muscle tone, and slow heart rate.
Therefore, it is typically prescribed only when other antibiotics are ineffective or contraindicated. It is administered in various forms, including tablets, capsules, eye drops, and ointments, depending on the type and severity of the infection. Due to its potential toxicity, close monitoring of patients during treatment is essential to manage any adverse reactions promptly.
It is commonly administered orally for the treatment of typhoid and paratyphoid fevers caused by sensitive Salmonella typhi and Salmonella paratyphi. After the patient's body temperature returns to normal and clinical symptoms are relieved, treatment should continue for an additional 10 days to ensure complete clearance of the pathogen and prevent recurrence. However, due to the gradual development of drug resistance in typhoid bacteria during epidemic periods, the time to fever reduction is longer compared to fluoroquinolones and third-generation cephalosporins, which are more commonly used as first-line drugs in such cases. During non-epidemic periods, typhoid bacteria are generally sensitive to this drug, making it suitable for treating sporadic cases caused by sensitive strains, especially in areas with low resistance rates.
This drug can also be used to treat Salmonella enteritis complicated by sepsis, as it can effectively penetrate into the blood circulation to reach the infected site and inhibit the proliferation of pathogenic Salmonella. However, it is ineffective against Salmonella carriers-individuals who harbor the bacteria but show no clinical symptoms-because it cannot completely eliminate the bacteria that colonize the intestinal tract, making it unsuitable for the eradication of carrier states.
It can easily cross the blood-ocular barrier, a key advantage for treating eye infections, and achieve effective therapeutic concentrations in various ocular tissues including the cornea, iris, sclera, conjunctiva, lens, aqueous humor, and optic nerve. This makes it an effective drug for treating external eye infections (such as conjunctivitis, keratitis), intraocular infections, total ocular infections, and trachoma caused by sensitive bacteria, with good clinical efficacy and mild local irritation.
It has considerable antibacterial activity against common anaerobes such as Bacteroides fragilis, Clostridium, and Peptostreptococcus, and can be used to treat anaerobic infections including abdominal abscesses, peritonitis after intestinal perforation, pelvic inflammatory disease, and wound infections. However, some anaerobes can produce specific enzymes that inactivate the drug, leading to treatment failure. In cases of mixed infections with Gram-negative bacteria, it is not usually used alone for severe infections such as anaerobic endocarditis, sepsis, or meningitis but is often combined with aminoglycoside antibiotics to enhance therapeutic effect and cover a broader spectrum of pathogens.
It can also be used for the treatment of rickettsial infections such as Rocky Mountain spotted fever and Q fever, with efficacy comparable to tetracycline antibiotics. In addition, it is clinically applied for the treatment of relapsing fever, plague, brucellosis, psittacosis, and gas gangrene. Notably, it can serve as a safe alternative for patients allergic to doxycycline, as well as pregnant women and children under 8 years old, for whom tetracycline antibiotics are contraindicated due to potential adverse effects.
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Adverse Reactions & Precautions
Despite its effectiveness, chloramphenicol has several adverse reactions that limit its use. High doses can inhibit the synthesis of host mitochondrial proteins due to the similarity between mammalian mitochondrial 70S ribosomes and bacterial 70S ribosomes. This can lead to anemia, leukopenia, and thrombocytopenia. Additionally, it can cause peripheral neuritis, optic neuritis, visual impairment, optic atrophy, and blindness. Other adverse reactions include insomnia, hallucinations, toxic psychosis, various skin rashes, drug fever, angioneurotic edema, contact dermatitis, and conjunctivitis. Long-term oral administration can inhibit intestinal flora, impeding the synthesis of vitamin K and inducing a tendency for bleeding. It can also cause secondary infections.
Therefore, when using it, it is essential to follow medical advice, monitor blood counts regularly, and discontinue use promptly if adverse reactions occur. Special attention should be paid to its use in children, pregnant women, and patients with liver dysfunction.
Scientific Research & Drug Development
Drug Metabolism Studies
Labeled with fluorescent dyes such as CY5.5 or indocyanine green (ICG) can be used to study its absorption, distribution, metabolism, and excretion (ADME) processes in vivo, providing important data for drug development.
Bioimaging and Tracking
The labeled product allows for real-time tracking and observation of its distribution and dynamic behavior within biological organisms using fluorescence imaging techniques. This aids in understanding its therapeutic mechanisms and assessing its targeting efficiency towards specific cells or tissues.
Cell Uptake Studies
Researchers can also study the uptake mechanisms of antibiotics by cells and the factors that influence this uptake using labeled product.
Pharmacokinetics
It is rapidly and completely absorbed after oral administration and can be widely distributed to various tissues and body fluids throughout the body. The distribution concentration in cerebrospinal fluid is higher than that of other antibiotics, and the oral bioavailability is 75% to 90%. Half an hour after oral administration, the effective concentration can be reached in the blood, reaching the peak in 2 to 3 hours. After taking 0.5g, 1g and 2g orally once, the blood concentration in 2 hours can reach 4mg/L, 8~10mg/L and 16~21mg/L respectively. Taking 1 to 2 g a day, orally divided into 4 times, can maintain an effective antibacterial concentration of 5 to 10 mg/L in the blood for a long time. After intravenous infusion, mean plasma concentrations are similar to those after oral administration of the same dose. After intramuscular injection, the absorption is slow and irregular, and the plasma concentration is only 50% of the same dose taken orally, but it lasts longer. The plasma protein binding rate is 50% to 60%. The half-life is 2 to 3 hours.
The half-life of newborns is significantly higher than that of adults. Children under 2 years old are about 24 hours, and those between 2 and 4 years old are about 12 hours. After absorption, this product is widely distributed in various tissues and body fluids throughout the body, with the highest content in the liver and kidneys, followed by the lungs, spleen, myocardium, intestines and brain. The content in bile is low, about 20% to 50% of the blood concentration. It can also enter pleural effusion, ascites, breast milk, fetal circulation and eye tissues. It can penetrate the blood-brain barrier and reach the cerebrospinal fluid.
The concentration in normal cerebrospinal fluid can reach 20% to 50% of the concentration in blood, and it can reach 50% to 100% in inflammation. Mainly metabolized in the liver, it is combined with glucuronic acid and inactivated. About 75% to 90% of the metabolites are excreted in the urine within 24 hours, of which 5% to 15% are unchanged drugs. After oral administration of 1g, the concentration in urine is 70-150 mg/L. In patients with severe liver disease, the half-life may be prolonged, and accumulation may cause poisoning due to reduced intrahepatic metabolism.
In the golden age of antibiotic development, the success of drugs such as streptomycin and penicillin inspired scientists around the world to frantically search for the next 'miracle bullet' from nature. In this magnificent history, the discovery story of chloramphenicol stands out. It is not only the first antibiotic to be produced on a large scale through artificial synthesis, but also the first truly 'broad-spectrum antibiotic', demonstrating almost miraculous efficacy against deadly diseases such as typhoid fever.
In the 1940s, the successful application of penicillin opened a new era of antibiotic treatment, but its limitations were also evident: it was ineffective against many Gram negative bacteria (such as typhoid bacilli and dysentery bacilli) and required fermentation production, which was complex, low in yield, and expensive. Meanwhile, although streptomycin is effective against Mycobacterium tuberculosis, its toxicity and resistance issues quickly emerged. Therefore, global research teams, especially pharmaceutical companies, have invested enormous resources in screening soil microorganisms for strains that can produce new antibacterial substances. This is a true 'soil gold rush', and chloramphenicol is the treasure unexpectedly discovered in this competition.
In 1946, botanist Professor Paul Burkhold isolated an actinomycete from a soil sample brought by a colleague from Venezuela. This sample is not from any mysterious rainforest, but from an ordinary farmland near the Venezuelan capital Caracas. This strain was named Streptomyces venezuelae in honor of its origin. Burkhold's team, including young graduate student David Gottlieb, found that the culture medium of the bacterium had strong antibacterial activity, not only inhibiting Gram positive bacteria, but also effective against Gram negative bacteria (such as Salmonella typhi and Haemophilus influenzae) that penicillin was unable to cope with at the time. This' broad-spectrum 'characteristic has immediately attracted great attention. They quickly invested in research, attempting to purify the active substances present.
Yale University's research quickly merged with industry. Burkhold collaborates with renowned pharmaceutical company Parker Davis, with chemists from the company leading the purification of active substances. A team of chemists led by M.C. Rebstock successfully isolated pure crystalline compounds from the culture medium of Streptomyces venerata in Venezuela. They named it Chlorophenol - a name derived from its molecular structural features: a chlorine containing benzene ring and an amide alcohol structure.
Similar news has also come from England across the Atlantic. A team of scientists from Eli Lilly and Company isolated a strain of actinomycetes called Streptomyces omiyaensis from soil samples from a farm in Urbana, Illinois, and extracted the same substance from its metabolites. They named it Chloromycin (one of the trade names for chloramphenicol). After comparison, it was confirmed that Chloramphenicol and Chloromycin are the same substance. In the end, Chloramphenicol became its generic name (INN). This transatlantic competition ended in a scientific 'draw', but Parker Davis took the lead in subsequent development and commercialization.
FAQ
Can chloramphenicol powder be used to treat wounds?
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Conclusion Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant.
Can you put chloramphenicol on skin?
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Chloramphenicol is a widely used topical ointment applied routinely to suture lines and skin grafts, particularly those on the face and around the eyes.
When should you not use chloramphenicol?
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304 stainless steel meets the international requirements of food grade,316 stainless steel is not only food grade or medical grade. However,the use of this medical grade as a production cup will not bring additional benefits to everyone. Why is it called 304 or 316? This is mainly defined according to the material composition. 316 stainless steel is not similar to mineral materials,after use can release some substances to promote human absorption.
Which license do lneed?
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If you are pregnant or breast-feeding. If you wear soft contact lenses. If you have ever had an allergic reaction to chloramphenicol or to any other eye drops. If anyone in your family has ever had a severe blood disorder.
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