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Outcome of case 5

Outcome of case 3
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© “Tunnel Vision” flickr photo by Momentchensammler shared under a Creative Commons (BY) license
This patient tolerated Chloramphenicol well for 19 weeks, but then developed blurred vision.

She was referred to ophthalmology who diagnosed optic neuritis, probably secondary to Chloramphenicol. This was stopped and her vision gradually improved over the next 3 months.

In our experience, prolonged oral Chloramphenicol is poorly tolerated by adult patients and should only be used when there are no other oral antibiotic options; serious adverse effects occur even when plasma drug levels are low (as was the case throughout in the patient described in steps 3.4 and 3.5. It is possible that it is better tolerated in children for at least 6 weeks (please find resources in the see also section below).

Following the discontinuation of Chloramphenicol, her knee deteriorated and she was subsequently commenced on Tedizolid 200mg once daily, which was now available to prescribe in the UK.

She subsequently agreed to undergo a knee fusion procedure. At our institution, we apply the same monitoring to Tedizolid as we do for Linezolid (see steps 2.5 onwards and 3.7 and 3.8).

© BSAC
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Intravenous to Oral Switch: Within Outpatient Parenteral Antibiotic Therapy (IVOST)

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