Chloramphenicol / fibrinolysin and desoxyribonuclease topical Disease Interactions
There is 1 disease interaction with chloramphenicol / fibrinolysin and desoxyribonuclease topical:
Chloramphenicol (Includes chloramphenicol/fibrinolysin and desoxyribonuclease topical) ↔ bone marrow suppression
Severe Potential Hazard, Low plausibility. Applies to: Bone Marrow Depression/Low Blood Counts
Chloramphenicol may cause bone marrow depression and other hematologic toxicities, which can be irreversible or reversible. The former type is independent of dose and results in aplastic anemia with a high rate of mortality, generally from hemorrhage or infection. It has been reported following both systemic and topical administration of chloramphenicol and has an estimated incidence of 1 in 25,000 to 1 in 40,000 courses of therapy. Bone marrow aplasia or hypoplasia may occur after a single dose but more often develops weeks or months after the drug has been discontinued. A reversible myelosuppression occurs much more frequently and is characterized by anemia, vacuolation of red blood cells, decreased reticulocyte count, leukopenia, thrombocytopenia, increased serum iron concentrations, and increased serum iron-binding capacity. It is dose-dependent, occurring regularly at chloramphenicol dosages exceeding 4 g/day (in adults) or at plasma drug concentrations >= 25 mcg/mL, and usually responds to withdrawal of the drug. Therapy with chloramphenicol should be administered cautiously, if at all, in patients with preexisting blood dyscrasias and/or bone marrow depression. Complete blood counts and differential reticulocyte counts should be performed in all patients prior to initiating therapy and approximately every 2 days during therapy. Marked depression of blood counts and/or development of other hematologic abnormalities may be indication for withdrawal of chloramphenicol therapy.
- Fraunfelder FT, Bagby GC, Kelly DJ "Fatal aplastic anemia following topical administration of ophthalmic chloramphenicol." Am J Ophthalmol 93 (1982): 356-60
- Del Giacco GS, Petrini MT, Jannelli S, Carcassi U "Fatal bone marrow hypoplasia in a shepherd using chloramphenicol spray." Lancet 1 (1981): 945
- Doona M, Walsh JB "Use of chloramphenicol as topical eye medication: time to cry halt? bone marrow aplasia also occurs with ocular use." BMJ 310 (1995): 1217-8
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- West BC, DeVault GA Jr, Clement JC, Williams DM "Aplastic anemia associated with parenteral chloramphenicol: review of 10 cases, including the second case of possible increased risk with cimetidine." Rev Infect Dis 10 (1988): 1048-51
- Abrams SM, Degnan TJ, Vinciguerra V "Marrow aplasia following topical application of chloramphenicol eye ointment." Arch Intern Med 140 (1980): 576-7
- Calderwood SB, Moellering RC "Common adverse effects of antibacterial agents on major organ systems." Surg Clin North Am 60 (1980): 65-81
- Alavi JB "Aplastic anemia associated with intravenous chloramphenicol." Am J Hematol 15 (1983): 375-9
- "Product Information. Chloromycetin (chloramphenicol)." Parke-Davis, Morris Plains, NJ.
- Farber BF, Brody JP "Rapid development of aplastic anemia after intravenous chloramphenicol and cimetidine therapy." South Med J 74 (1981): 1257-8
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
|No interaction information available.|
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