Chloramphenicol


Antibiotic produced by Streptomyces venezuelae. It comprises a nitrobenzene ring linked to propanol, with an amide group binding to a derivative of dichloroacetamide acid.
 
Incidence
Uncommon.
 
Risk factors
Allergy to penicillin.
 
Severe infection.
 
Previous exposure to phenicols.
 
Clinical manifestations
Topical use of chloramphenicol may lead to: contact dermatitis, anaphylactic shock, aplastic anemia.
 
General: anaphylactic shock, fever.
 
Respiratory: bronchospasm.
 
Cutaneous: urticaria, maculopapular rash, angioedema, contact dermatitis.
 
Haematological: aplastic anemia.
 
Diagnostic methods
Cutaneous testing
 
Positive scratch and patch test reported in some cases involving cutaneous manifestations (patch-tests with chloramphenicol 1% in pet).
 
Antibodies against chloramphenicol have been found, with no obvious clinical manifestation.
 
Mechanisms
Unknown.
 
The dichloroacetamide ring is probably the major antigenic determinant.
 
Management
Avoidance.
 
Cross-sensitivity between chloramphenicol and synthetic derivatives is likely.

References

  1. Le Coz C.J, Santinelli F, "Facial contact dermatitis from chloramphenicol with cross-sensitivity to thiamphenicol", Contact. Dermatitis., 1998 ; 38:
    108-9
  2. Moyano J.C, Alvarez M, Fonseca J.L, Bellido J, Munoz-Bellido F.J, "Allergic contact dermatitis to chloramphenicol", Allergy., 1996 ; 51 (1): 67-9
  3. Mc Ghee C.N.J, Anastas C.M, "Widespread ocular use of topical chloramphenicol: is there justifiable concern regarding idiosyncratic aplastic anaemia?", Br. J. Ophtalmol., 1996 ; 80 (2): 182-4
  4. Liphshitz I, Loewenstein A, "Anaphylactic reaction following application of chloramphenicol eye ointment", Br. J. Ophtalmol., 1991 ; 75 (1): 64
  5. Schewach-Millet M, Shapiro D, "Urticaria and angioedema due to topically applied chloramphenicol ointment", Arch. Dermatol., 1985 ; 121: 587.
  6. Palchick B.A, Funk E.A, Mc Entire J.E, Hamory B.H, "Anaphylaxis due to chloramphenicol", Am. J. Med. Sci., 1984 ; 288 (1): 43–5.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.