Chloramphenicol: New possibilities of the old drug

One of the central problems of pharmacotherapy for infectious diseases is the active rise of antibiotic resistance to the most commonly used drugs, which leads to a shortage of effective patient management strategies. A possible alternative in this situation can be an evaluation of the modern abilities of antibacterial drugs, the use of which in clinical practice has been minimized over the past decades. An example of such a drug is chloramphenicol, the systemic application of which has been sharply limited since the 1960s because of reports on toxic reactions (aplastic anemia, gray baby syndrome). Topical chloramphenicol is characterized by the low level of systemic absorption and by the absence of its ability to cause a range of side effects typical for systemic use. The high antibacterial activity of chloramphenicol against a wide range of gram-negative and gram-positive pathogens (Morganella morganii, Empedobacter brevis, Burkholderia cepacia, Bacteroides spp., H. influenzae, Salmonella typhi, Staphylococcus aureus (including MRSA), Streptococcus pneumonia, Streptococcus pyogenes, Gardnerella vaginalis, Mycoplasma pneumoniae, Mycoplasma hominis, and Ureaplasma spр.), including resistant strains, allows its use in a variety of infectious diseases. The mechanism of action and structure of the drug, which distinguish it from other classes of antibacterial agents, make it possible to produce an effective effect, including on pathogens that do not contain penicillin-binding proteins (mycoplasma) in the cell wall. According to the published data, a comparative analysis of the safety profile of systematically used chloramphenicol has revealed no significant differences in that of representatives of other groups of antibacterial drugs, with the exception of anemia cases. The studies on the application of topical chloramphenicol in pregnant women have not revealed its teratogenic potential of the drug when used during 2–3 months of pregnancy. Conclusion: The pooled data suggesting that chloramphenicol has high activity against a broad range of pathogens, therapeutic efficacy, and a satisfactory safety profile when applied topically in various fields (clinical studies in ophthalmology and gynecology) indicates that its intravaginal formulation can be used to treat bacterial vaginosis. © 2021, Bionika Media Ltd. All rights reserved.