Can Chloramphenicol Be Safely Used for Children with G6PD Deficiency?

Is chloramphenicol safe to use in patients with G6PD deficiency?

Dear Dr.
Hsiao,
Hello! You previously addressed the medication for Favism in the following article, thank you very much! https://adoctor.tw/article/58638 My child has developed a stye, and the ophthalmologist prescribed Chloramphenicol (0.25% Chloramphenicol Eye Drops, generic name: CHLORAMPHENICOL, brand: Jianqiao).
Since he has Favism, I usually check his medications.
However, I found on this foreign website that it specifically mentions that Asians should avoid it.
https://www.g6pd.org/en/G6PDDeficiency/SafeUnsafe/DaEvitare_ISS-it, on pages 2 and 3 regarding certain medications.
Could you please clarify whether Chloramphenicol and similar medications can be used in the future? Thank you once again!

Liu Ba, 50~59 year old female. Ask Date: 2021/06/15

Dr. Xiao Kaiwen reply Pediatrics

Chloramphenicol is not suitable for Asians, specifically in its oral form.
Oral chloramphenicol can sometimes cause bone marrow suppression as a side effect, and its use has been banned in Taiwan.
However, topical ophthalmic chloramphenicol has minimal systemic absorption, so it can be used.
It is also permissible for individuals with G6PD deficiency.

Reply Date: 2021/06/15

More Info

Chloramphenicol is an antibiotic that has been used for various infections, including eye infections such as conjunctivitis and styes (commonly referred to as "針眼" in Mandarin). However, when it comes to its use in children with G6PD deficiency (also known as favism), caution is warranted.

G6PD deficiency is a genetic condition that affects the enzyme glucose-6-phosphate dehydrogenase, which plays a crucial role in protecting red blood cells from oxidative damage. Individuals with this deficiency are at risk of hemolytic anemia when exposed to certain triggers, including specific medications, foods, and infections.
Chloramphenicol has been associated with potential adverse effects in individuals with G6PD deficiency, particularly because it can cause bone marrow suppression and may lead to aplastic anemia. While chloramphenicol is not explicitly listed as a contraindicated medication for G6PD deficiency in all guidelines, it is essential to consider the individual patient's health status and the potential risks versus benefits of using this medication.

The concern you raised about the specific warning for Asian populations regarding chloramphenicol is valid. Some studies suggest that certain populations may have a higher risk of adverse reactions to this antibiotic, which could be due to genetic factors or variations in drug metabolism. Therefore, it is crucial to approach the use of chloramphenicol with caution in children with G6PD deficiency, especially if there are alternative treatment options available.

In your case, since your child has been prescribed chloramphenicol for a stye, it is advisable to discuss this with the prescribing physician. You can express your concerns regarding G6PD deficiency and ask if there are safer alternatives. Other antibiotics, such as topical antibiotics like bacitracin or polymyxin B, may be considered, depending on the severity of the infection and the physician's judgment.

Additionally, it is essential to monitor your child for any signs of adverse reactions while using chloramphenicol, such as unusual fatigue, pallor, jaundice (yellowing of the skin or eyes), or any signs of bleeding or bruising. If any of these symptoms occur, it is crucial to seek medical attention immediately.

In summary, while chloramphenicol can be effective for treating eye infections, its use in children with G6PD deficiency should be approached with caution. Always consult with a healthcare professional who is knowledgeable about G6PD deficiency and can provide personalized medical advice based on your child's specific health needs.

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