User:C.Santamaria, UCSF PharmD candidate/sandbox

"Also, due to the risk of bone marrow suppression associated with chloramphenicol use, both the doctor and the pharmacist need to check for concomitant usage of other medications that also carries the risk of decreasing blood cell counts. Examples of drugs that can also cause bone marrow suppression include rifampicin, carbimazole, and trimethoprim. These medications should not be administered together with chloramphenicol."

"Examples of drugs that can also cause bone marrow suppression include rifampicin, carbimazole, and trimethoprim. These medications should not be administered together with chloramphenicol."

https://www.ncbi.nlm.nih.gov/books/NBK555966/

Medication reconciliation of other medications that neonates may be taking that can decrease blood cell count should be monitored because of this medication's ability to suppress bone marrrow activity.

Rifampicin and trimethoprim are examples of medications with bone marrow suppression abilities and are contraindicated for concomitant use with chloramphenicol.

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"Empiric administration of broad-spectrum antibiotics such as vancomycin, ampicillin (targeting Listeria), and a third-generation cephalosporin such as ceftriaxone or cefotaxime is recommended"

https://www.ncbi.nlm.nih.gov/books/NBK448133/

With sepsis being a complication of severe grey baby syndrome, usage of broad spectrum antibiotics such as vancomycin, for example, is a recommended treatment option.

Phenobarbital and theophylline are two drugs in particular that have shown significant efficacy with charcoal hemoperfusion, aside from its most significant indication for chronic aluminum toxicity in patients with end-stage renal disease (ESRD) traditionally.

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"Chloramphenicol causes two types of bone marrow damage [21].

** Citation
 * A frequent, early, dose-related, reversible suppression of the formation of erythrocytes, thrombocytes, and granulocytes (early toxicity).
 * A rare, late type of bone marrow aplasia, a hypersusceptibility reaction, which is generally irreversible, and has a high mortality rate (aplastic anemia) [22–24]."
 * -- In regards to bone marrow suppression, chloramphenicol has two major etiological manifestations. The first mechanism of bone marrow suppression affects the formation of blood cells such as erythrocytes and can be reversible since it is an early sign up toxicity. The second form of bone marrow suppression is bone marrow aplasia which is associated with being late into toxicity and cannot be reversed in some cases.
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"Chloramphenicol is a lipid soluble compound lacking acidic and basic groups that could form salts. As a consequence, the naturally occurring compound is most soluble in organic solvents, and has a maximum solubility in water of only 4 mg/ml.7 This relative insolubility requires large administration volumes which is a disadvantage in neonates and children."

https://pediatrics.aappublications.org/content/64/3/348.long

Chloramphenicol is significantly insoluble due to an absence of acidic and basic groups in its molecular compound. As a result, larger amounts of the medication are required to achieve the desired therapeutic effect. High volumes of a medication that can cause various toxicities is another avenue how chloramphenicol can potentially lead to grey baby syndrome.