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Snapshot
  • A 33-year-old man presents to the emergency department for fever, headache, and rash. His symptoms are accompanied by myalgias and malaise and began approximately 3 days ago. He returned from a trip in North Carolina, where he believes he was bitten by a tick. He has no significant past medical history. He is severely allergic to penicillin and doxycycline. Physical examination is notable for a blanching erythematous rash with macules on the wrist and ankles. He is started on chloramphenicol. (Rocky Mountain spotted fever)
Introduction
  • Mechanism of action 
    • reversibly binds to the 50S ribosomal subunits, blocking peptidyltransferase and impairing protein synthesis
      • bacteriostatic
        • prevents bacterial reproduction
  • Mechanism of resistance
    • drug inactivation via a plasmid-encoded acetyltransferase
  • Clinical use
    • meningitis
      • Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae
    • Rocky Mountain spotted fever
  • Adverse events
    • aplastic anemia (dose independent) 
    • anemia (dose dependent)
    • gray baby syndrome 
      • seen in premature infants due to their lack of liver UDP-glucuronosyltransferase

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