Aplastic anemia The most serious side effect of<unk>  treatment is aplastic anaemia. This effect is rare and sometimes fatal. The risk of AA is high enough that alternatives should be strongly<unk> onsidered. Treatments are available but expensive. No way exists to predict who may or may not get this side effect. The effect usually occurs weeks or months after treatment has been stopped, and a genetic predisposition may be involved. It is not known whether monitoring the blood<unk> ounts of patients<unk> an prevent the development of aplastic anaemia, but patients are recommended to have a baseline blood<unk> ount with a repeat blood<unk> ount every few days while on treatment.<unk>  should be discontinued if the<unk> omplete blood<unk> ount drops. The highest risk is with oral<unk>  (affecting 1 in 24,000–40,000) and the lowest risk occurs with eye drops (affecting less than one in 224,716 prescriptions). Thiamphenicol, a related<unk> ompound with a similar spectrum of activity, is available in Italy and<unk> hina for human use, and has never been associated with aplastic anaemia. Thiamphenicol is available in the U.S. and Europe as a veterinary antibiotic, but is not approved for use in humans. Bone marrow suppression<unk>  may<unk> ause bone marrow suppression during treatment; this is a direct toxic effect of the drug on human mitochondria. This effect manifests first as a fall in hemoglobin levels, which occurs quite predictably once a<unk> umulative dose of 20 g has been given. The anaemia is fully reversible once the drug is stopped and does not predict future development of aplastic anaemia. Studies in mice have suggested existing marrow damage may<unk> ompound any marrow damage resulting from the toxic effects of<unk> . Leukemia Leukemia, a<unk> ancer of the blood or bone marrow, is<unk> haracterized by an abnormal increase of immature white blood<unk> ells. The risk of<unk> hildhood leukemia is increased, as demonstrated in a<unk> hinese<unk> ase–control study, and the risk increases with length of treatment. Gray baby syndrome Intravenous<unk>  use has been associated with the so-called gray baby syndrome. This phenomenon occurs in newborn infants because they do not yet have fully functional liver enzymes (i.e. UDP-glucuronyl transferase), so<unk>  remains unmetabolized in the body. This<unk> auses several adverse effects, including hypotension and<unk> yanosis. The<unk> ondition<unk> an be prevented by using the drug at the recommended doses, and monitoring blood levels. Hypersensitivity reactions Fever, macular and vesicular rashes, angioedema, urticaria, and anaphylaxis may occur. Herxheimer's reactions have occurred during therapy for typhoid fever. Neurotoxic reactions Headache, mild depression, mental<unk> onfusion, and delirium have been described in patients receiving<unk> . Optic and peripheral neuritis have been reported, usually following long-term therapy. If this occurs, the drug should be promptly withdrawn.
Chloramphenicol
Tetracycline
Thiamphenicol
Minocycline
Natamycin
Meropenem
Methicillin
Amikacin