Chloramphenicol has a very wide spectrum of activity, including most Gram-positive and Gram-negative species (not Pseudomonas species), anaerobes, and Rickettsia, but because of increasing resistance among H. influenzae and Strep. pneumoniae, it is no longer the drug of choice for empirical treatment of meningitis. It penetrates well into most tissues and is metabolized in the liver. Reversible bone marrow suppression can develop at dose of 4 g/day or on long courses. Serum concentrations should be measured in the very young and should not rise above 20 mg/l to avoid gray baby syndrome (vomiting, cyanosis, collapse). In occasional cases (1 in 30 000) a fatal aplastic anemia develops. The principle uses of chloramphenicol are treatment of meningitis in patients allergic to cephalosporins, brain abscess, and rickettsial infection.
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