Dosing and uses of Chloramphenicol IV, Chloromycetin (chloramphenicol)
Adult dosage forms and strengths
injectable solution
- 1000mg/vial
Serious Infections Caused by Susceptible Strains
50 mg/kg/day IV divided q6hr; in exceptional cases, patients with moderately resistant organisms or severe infections may require increased dosage up to 100 mg/kg/day; decrease these high doses as soon as possible
Other Indications & Uses
Use only as alternative for treatment of meningitis, typhoid, or rickettsial infection
Pediatric dosage forms and strengths
injectable solution
- 1000mg/vial
Systemic Infections
Infants and children: As in adults; when adequate cerebrospinal fluid concentrations desired, may require up to 100 mg/kg/day; however, should reduce dose to 50 mg/kg/day as soon as possible
Infants and children with suspected immature metabolic functions: 25 mg/kg/day divided q6hr will usually produce therapeutic concentrations of the drug in the blood
Neonates (<28 Days Old)
Loading dose (LdD): 20 mg/kg IV once; give maintenance dose 12 hours after loading dose
Maintenance Dose
- <7 days old: 25 mg/kg/day IV q24hr
- >7 days old, <2000 g: 25 mg/kg/day IV q24hr
- >7 days old, >2000 g: 50 mg/kg/day IV divided q12hr
Other Information
Peaks 10-20 mg/L, troughs 5-10 mg/L
Chloramphenicol IV, Chloromycetin (chloramphenicol) adverse (side) effects
<1%
Nightmares
Headache
Rash
Diarrhea
Stomatitis
Enterocolitis
Nausea
Vomiting
Bone marrow suppression
Aplastic anemia
Peripheral neuropathy
Optic neuritis
Gray syndrome
Warnings
Black box warnings
Serious and fatal blood dyscrasias, including aplastic anemia, hypoplastic anemia, thrombocytopenia, and granulocytopenia, have occurred after short-term and prolonged therapy
Monitor CBC frequently in all patients. Use only in serious infections
Contraindications
Hypersensitivity
Do not use oral or topical; not for use in trivial infections or for prophylaxis
Avoid during breastfeeding
Pregnancy and lactation
Pregnancy category: C
Lactation: enters breast milk; discontinue drug or do not nurse
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Chloramphenicol IV, Chloromycetin (chloramphenicol)
Distribution: to most tissues & body fluids; readily crosses placenta; enters breast milk CSF: blood level ratio: normal meninges: 66%; inflamed meninges: >66%
Protein Bound: 60%
Half-life Elimination
Normal renal function: 1.6-3.3 hr
End-stage renal disease: 3-7 hr
Cirrhosis: 10-12 hr
Excretion
Urine: 5-15%
Feces: 4%
Other Information
Metabolism: extensively hepatic (90%) to inactive metabolites, principally by glucuronidation; chloramphenicol palmitate is hydrolyzed by lipases in GI tract to the active base; chloramphenicol sodium succinate is hydrolyzed by esterases to active base
Mechanism of action
Inhibits bacterial protein synthesis by binding to 50S ribosomal subunit; mainly bacteriostatic
Administration
IV Incompatibilities
Additive: chlorpromazine, hydroxyzine, phenytion, polymyxin B sulfate, prochlorperazine, promethazine, vancomycin
Syringe: glycopyrrolate, metoclopramide
Y-site: fluconazole
IV Compatibilities
Solution: compatible with most common solvents
Additive (partial list): amikacin, aminophylline, ascorbic acid, CaCl2, Ca-gluconate, dimenhydrinate, dopamine, heparin, KCl, MgSO4, metronidazole, NaHCO3
Syringe: ampicillin, heparin, penicillin G sodium
Y-site: acyclovir, cyclophosphamide, enalaprilat, esmolol, foscarnet, hydromorphone, labetalol, MgSO4, meperidine, morphine, nicardipine, perphenazine, tacrolimus
IV Preparation
pH: 6.4-7.0
IV Administration:
Infuse via direct IV over 3-5 min; intermittent infusion over 30-60 min
