Chloramphenicol + Prednisolone Pharmacology
Chloramphenicol + Prednisolone
Chloramphenicol
2.Aplastic anaemia
3.Agranulocytosis
4.Thrombocytopenia
5.Gray baby syndrome
6.Super infections
7.Rashes & Hypersensitivity reactions
8.Angioedema
9.Nausea
10.Vomiting
11.Diarrhoea
12.Pain at injection site
2.As a prophylactic agent in infections & In the treatment of trivial infections
2.Hepatic impairment
3.Concurrent use of other drugs which cause bone marrow suppression
4.Porphyria
5.G6PD deficiency
Neonates: Contraindicated
2.Typhoid fever
3.Brain abscesses
4.Wound infections
5.Pelvic inflammatory diseases
6 Conjunctivitis & Intraocular infections
7.Anaerobic infections
8.Ear infection
9.Infections where other antibiotics are not effective
10.In urinary tract infections
Cyclophosphamide: Efficacy reduced.
Acetaminophen: Efficacy of Chloramphenicol potentiated leading to toxicity.
Iron salts and Vit. B12: Haematologic response decreased.
Penicillin: Decreases efficacy of penicillin and increases serum concenteration of chloramphenicol.
Rifampicin: Reduces serum chloramphenicol levels (hepatic enzyme induction).
Tricyclic Anti-Depressants: Blood levels and adverse effects increased.
Mannitol & Hydrochlorothiazide: Increases renal excretion of chloramphenicol.
0.25 to 0.5gm four times daily or 50mg/kg/day
In severe infections & Meningitis: 100mg/kg/day four times daily
Maximum total dose: 28gm
Children:
25 to 50mg/kgm/day four times daily
In severe infections: 100mg/kg/day four times daily
Prednisolone
The drug exerts anti-inflammatory and immunosuppressant actions as follows: - 1) Induce lipocortins in macrophages, endothelium, and fibroblasts which inhibits phospholipase A2 and thus decreases the production of Prostaglandins, leukotriens (LT), and platelet activating factor, 2) Causes negative regulation of genes for cytokines in macrophages, endothelial cells and lymphocytes and thus decreases the production of interleukins (IL-1, IL-2, IL-3, IL-6), TNF-a, GM-CSF (granulocyte macrophage colony stimulating factor), Gama interferon and suppresses fibroblast proliferation and T-lymphocyte functions and interferes chemo taxis. 3) Decreases the production of acute phase reactants from macrophages and endothelial cells and interferes complement function. 4) Decreases the production of ELAM-1(Endothelial leukocyte adhesion molecule-1) and ICAM-1(intracellular adhesion molecule-1) in endothelial cells. 5) Inhibit IgE mediated histamine and LT-C4 release from basophiles and the effects of antigen-antibody reaction is not mediated 6) Reduces the production of collagenase and stromolysin and thus prevents tissue destruction
2.Peptic ulcer
3.Haemorrhage
4.Glycosuria
5.Hyperglycaemia
6.Osteoporosis
7.Atrophy of adrenal cortex(on prolonged therapy)
8.Suppression of adrenocorticotropic hormone
9.Cushing`s syndrome
10.Inhibition of growth in children
11.Amenorrhoea
12.Behavioral disturbances
13.Thromboembolic disorders
14.Myopathy
15.Weakness
16.Lymphocytopenia
17.Muscle wasting
18.Gastrointestinal discomfort
19.Increased appetite
20.Delayed wound healing
21.Headache
22.Euphoria
23.Insomnia
24.Seizures
25.Heart failure
26.Arrhythmias
27.Posterior sub capsular cataract
28.Glaucoma
29.Increased intracranial pressure
2.Peptic ulcer
3.Systemic Infections
4.Fungal infections
5.Live vaccines
2.Tuberculosis
3.Osteoporosis
4.Ocular herpes simplex
5.Primary glaucoma
6.Peptic ulcer
7.Primary psychosis and psychoneurosis
8.Recent myocardial infarction
9.Heart failure
10.Diabetes mellitus
11.Hypothyroidism
12.Cirrhosis
13.Stress
14.Sepsis
15.Hypertension
16.Myasthenia gravis
17.Renal impairment
18.Hepatic impairment
19.Non specific Ulcerative colitis
20.Diverticulitis
21.Recent intestinal anastomosis
22.Seizures
23.Thromboembolic disorders
Neonates: Contraindicated
2.Anaphylaxis
3.Inflammatory conditions
4.Rheumatic disorders
5.Autoimmune diseases
6.Asthma
7.Inflammatory bowel disease
8.Malignancies
9.Acute gout
Oral contraceptives: May increase concentration of prednisolone.
Oestrogens: May decrease the clearance of prednisolone.
Ketoconazole: Increases efficacy of prednisolone.
Rifampicin: Decreases efficacy.
Prednisolone affects the actions of the following:
Anticholinesterases: Effects may be antagonised in myasthenia gravis.
Cyclosporine: May lead to enhanced toxicity.
Digitalis glycosides: May lead to enhanced toxicity.
Isoniazid: Decreased serum levels of isoniazid.
Salicylates: Decreased serum levels of salicylate.
Diuretics: May cuase hypokalaemia and increased hyperglycaemia.
Non-depolarising muscle relaxants: Altered response.
Somatrem: Growth promoting effect inhibited.
Theophyllines: Altered response of either agent.
IUCD: contraceptive failure.
Lab. Tests:
a) Increases serum cholesterol levels.
b) Increases urine glucose levels.
c) Decreases Thyroid I131 uptake; Decreases T3 serum levels.
d) Decreases serum potassium.
Children: 0.15 to 2mg/kg/day in 4 to 6 divided doses; depending up on the severity of the condition and patient`s response.
I.M. or I.V.: 2 to 30mg 12th hourly
Intra-articular: 5 to 25mg Prednisolone acetate.
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