Nidependiol

Indications

Chloramphenicol is an antibiotic. In everyday use it is mainly applied to the eye and ear:

• Eye drops and eye ointment: bacterial eye infections such as conjunctivitis (red, sticky eye).
• Ear drops: bacterial infections of the outer ear.
• Capsules and injection: serious infections such as typhoid fever and bacterial meningitis, used only when safer antibiotics are not suitable, usually in hospital.

How It Works

Chloramphenicol stops bacteria from making the proteins they need to grow and multiply, which allows the body to clear the infection.

Dosage and Administration

• Eye drops (0.5%), adults and children over 2 years: 1 drop in the affected eye every 2 hours for the first 2 days, then 1 drop four times a day. Usual total course is 5 days.
• Eye ointment (1%): apply a small amount inside the lower eyelid three or four times a day, or at night if drops are used during the day.
• Ear drops: 2 to 3 drops into the ear two or three times a day, as advised.
• Capsules and injection: dose by body weight, as prescribed. The injection is given by a doctor or nurse.
• Children under 2 years: only as prescribed.

Wash hands before and after use, and do not let the dropper touch the eye.

Interactions

Eye and ear drops rarely cause interactions. Capsules and injections can increase the effects of Phenytoin, Warfarin, Glibenclamide and other sulfonylureas, Ciclosporin and Tacrolimus. Rifampicin and Phenobarbital lower chloramphenicol levels. Avoid using it with other medicines that can suppress the bone marrow, such as Clozapine and Carbamazepine. It may reduce the response to some vaccines and to iron and vitamin B12 treatment.

Contraindications

• Allergy to chloramphenicol or any ingredient of the product.
• A past blood disorder or bone marrow problem, especially one caused by chloramphenicol, or a family history of such problems.
• Capsules and injection: porphyria, and use in late pregnancy or breastfeeding.

Side Effects

Eye and ear products: brief stinging, burning or blurred vision after applying. Capsules and injection: nausea, vomiting, diarrhoea and mouth soreness. The most serious risk is bone marrow damage, which can lower blood cell counts; very rarely this is permanent (aplastic anaemia), and this has been reported very rarely even with eye drops. In newborn babies, high doses can cause a serious condition called grey baby syndrome.

Get urgent medical help for unusual bruising or bleeding, sore throat with fever, unusual tiredness or paleness, swelling of the face or throat, difficulty breathing, or eye pain or loss of vision.

Pregnancy and Lactation

Capsules and injections should be avoided in pregnancy, especially near delivery, and during breastfeeding because of the risk to the baby. Eye and ear drops should be used in pregnancy and breastfeeding only if a doctor advises.

Precautions and Warnings

• With capsules or injections, regular blood counts are needed, and long or repeated courses should be avoided.
• Use with care in liver or kidney disease.
• Remove contact lenses during treatment of an eye infection.
• See a doctor if the eye does not improve within 48 hours, or if there is eye pain, sensitivity to light, reduced vision, or a recent eye injury.

Overdose

Swallowing a bottle of eye drops is unlikely to be harmful, but seek advice if a child does. Overdose of capsules or injection can cause vomiting, low body temperature, breathing problems and collapse, and needs urgent hospital care.

Therapeutic Class

Antibiotic (amphenicol group).

Storage

Capsules: store below 30°C in a dry place, away from light. Eye drops: follow the label; many need to be kept in the fridge (2 to 8°C) before opening. Discard eye products 28 days after opening, or sooner if the label says. Keep out of reach of children.