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Updated: Sep 14 2019


  • 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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