Brand and Other Names:Chloramphenicol IV, Chloromycetin
- Classes: Antibiotics, Other
Dosing & Uses
Dosage Forms & Strengths
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
Dosage Forms & Strengths
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)
- <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
Peaks 10-20 mg/L, troughs 5-10 mg/L
Serious - Use Alternative
Significant - Monitor Closely
Bone marrow suppression
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
Do not use oral or topical; not for use in trivial infections or for prophylaxis
Avoid during breastfeeding
Pregnancy & Lactation
Pregnancy Category: C
Lactation: enters breast milk; discontinue drug or do not nurse
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.
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%
Normal renal function: 1.6-3.3 hr
End-stage renal disease: 3-7 hr
Cirrhosis: 10-12 hr
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
Additive: chlorpromazine, hydroxyzine, phenytion, polymyxin B sulfate, prochlorperazine, promethazine, vancomycin
Syringe: glycopyrrolate, metoclopramide
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
Infuse via direct IV over 3-5 min; intermittent infusion over 30-60 min
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