Chloramphenicol Sodium Succinate and Evenity

• Generic Name: chloramphenicol
• Dosage Forms: n.a.
• Other Brand Names:

Alternative for treatment of meningitis caused by susceptible bacteria, including Haemophilus influenzae, Neisseria meningitidis, or Streptococcus pneumoniae. Generally used only when penicillins and cephalosporins are contraindicated or ineffective.

Despite evidence of in vitro activity against Listeria monocytogenes, has been ineffective for treatment of systemic infections caused by this organism.

Do not use for treatment of meningitis caused by gram-negative bacilli.

Possible alternative to tetracyclines for treatment of rickettsial infections. CDC and other experts state that doxycycline is the drug of choice for treatment of all rickettsial infections in all age groups (including children <8 years of age). Some of these infections can be rapidly progressive and may be fatal or lead to long-term sequelae; do not delay empiric treatment while waiting for confirmatory testing. If considering an alternative to doxycycline, consultation with an expert recommended.

Possible alternative to doxycycline for treatment of certain tickborne rickettsial diseases, including Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii. Doxycycline is drug of choice for treatment of RMSF, regardless of patient age. Consider chloramphenicol only in certain patients when doxycycline cannot be used (e.g., those with history of potentially life-threatening allergic reactions to doxycycline, pregnant women). There is some epidemiologic evidence that risk of death in patients with RMSF is higher in those treated with chloramphenicol than in those treated with a tetracycline; close monitoring required if chloramphenicol used.

Possible alternative to doxycycline for treatment of endemic typhus (murine typhus; fleaborne typhus) caused by R. typhi or R. felis and for treatment of epidemic typhus (louseborne typhus; sylvatic typhus) caused by R. prowazekii. Doxycycline is drug of choice for treatment of endemic typhus and epidemic typhus, regardless of patient age.

Has been used for treatment of scrub typhus caused by Orientia tsutsugamushi; recommended as possible alternative to doxycycline. Consider that chloramphenicol resistance and persistence or relapse reported.

Do not use for treatment of anaplasmosis caused by Anaplasma phagocytophilum (also known as human granulocytic anaplasmosis; HGA) or ehrlichiosis caused by Ehrlichia chaffeensis (also known as human monocytic ehrlichiosis; HME). Doxycycline is drug of choice for treatment of human ehrlichiosis and anaplasmosis, regardless of patient age. Chloramphenicol considered ineffective; use not supported by results of in vitro susceptibility testing.

Has been used for treatment of typhoid fever (enteric fever) caused by susceptible Salmonella enterica serovar Typhi and treatment of paratyphoid fever caused by S. enterica serovar Paratyphi.

Although chloramphenicol was a drug of choice for treatment of infections caused by typhoidal Salmonella in the past, multidrug-resistant strains of S. enterica serovar Typhi (i.e., strains resistant to ampicillin, chloramphenicol, and/or co-trimoxazole) are reported worldwide and common in many regions of the world. Whenever possible, select anti-infectives for treatment of typhoid fever based on results of in vitro susceptibility testing.

Do not use to treat typhoid carrier state. Depending on susceptibility of the strain, a fluoroquinolone (e.g., ciprofloxacin), ampicillin, amoxicillin, or co-trimoxazole usually recommended to treat typhoid carrier state.

Do not use for treatment of uncomplicated Salmonella gastroenteritis.

Alternative for treatment of anthrax.

Has in vitro activity against Bacillus anthracis, but limited clinical data exist regarding use in the treatment of anthrax.

Although chloramphenicol has been suggested as an alternative for treatment of naturally occurring anthrax in patients hypersensitive to penicillins or as one of several options for use in multiple-drug regimens for treatment of anthrax, WHO states chloramphenicol is no longer recommended for such infections because evidence of in vivo efficacy in treatment of severe anthrax is lacking and the drug is associated with serious adverse effects.

For treatment of inhalational anthrax that occurs as the result of exposure to B. anthracis spores in the context of biologic warfare or bioterrorism, CDC, AAP, and the US Working Group on Civilian Biodefense recommend initial treatment with a multiple-drug parenteral regimen that includes a fluoroquinolone (preferably ciprofloxacin) or doxycycline and 1 or 2 additional anti-infectives predicted to be effective (e.g., clindamycin, rifampin, a carbapenem [doripenem, imipenem, meropenem], chloramphenicol, vancomycin, penicillin, ampicillin, linezolid, gentamicin, clarithromycin).

For treatment of systemic anthrax with possible or confirmed meningitis, CDC and AAP recommend a regimen of IV ciprofloxacin with an IV bactericidal anti-infective (preferably meropenem) and an IV protein synthesis inhibitor (preferably linezolid). These experts recommend IV chloramphenicol as a possible alternative to linezolid, but use only if clindamycin and rifampin not available.

Has been used in patients with cystic fibrosis and has been recommended as an alternative for treatment of infections caused by Burkholderia cepacia. However, B. cepacia usually resistant to chloramphenicol in vitro. Optimum treatment regimens for chronic B. cepacia complex infections not identified; select treatment regimen based on in vitro susceptibility data and previous clinical responses. Anti-infectives that have been recommended include meropenem, imipenem, co-trimoxazole, ceftazidime, doxycycline, and chloramphenicol; some experts recommend use of multiple-drug regimens.

Has been used in conjunction with doxycycline and co-trimoxazole for treatment of melioidosis caused by B. pseudomallei. Ceftazidime or a carbapenem (either meropenem or imipenem) usually drugs of choice for initial treatment, followed by long-term treatment (≥3 months) with an oral anti-infective (e.g., co-trimoxazole, amoxicillin and clavulanate potassium, doxycycline). B. pseudomallei may be difficult to eradicate and relapse of melioidosis may occur, especially if there is poor compliance with the follow-up regimen.

Alternative for treatment of plague caused by Yersinia pestis, including naturally occurring or endemic plague or pneumonic plague that occurs following exposure to Y. pestis in the context of biologic warfare or bioterrorism.

Streptomycin (or gentamicin) historically considered drug of choice for treatment of plague. Alternatives include fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin), doxycycline (or tetracycline), chloramphenicol, or co-trimoxazole (may be less effective than other alternatives).

Chloramphenicol considered a drug of choice for treatment of plague meningitis.

Alternative for treatment of tularemia caused by Francisella tularensis, including naturally occurring or endemic tularemia or tularemia that occurs following exposure to F. tularensis in the context of biologic warfare or bioterrorism.

Streptomycin (or gentamicin) generally considered drug of choice for treatment of tularemia. Alternatives include tetracyclines (doxycycline), chloramphenicol, or ciprofloxacin.

Some clinicians state reserve chloramphenicol for treatment of tularemic meningitis (usually in conjunction with streptomycin) and do not use for other forms of tularemia.

• Generic Name: romosozumab
• Dosage Forms: injection, solution
• Other Brand Names: Evenity

Evenity (romosozumab) is a sclerostin inhibitor. Sclerostin suppresses bone formation.

Evenity is a prescription medicine used to treat osteoporosis in postmenopausal women with a high risk of bone fracture who cannot use other osteoporosis medications (or when other medications did not work).

It is not known if Evenity is safe and effective in children. .