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Chloramphenicol
Pham P and Bartlett JG
03-19-2008
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Available formulation in Zambia: Capsule: 250 mg. Oily suspension for injection: 0.5 g (as sodium succinate)/ml in 2 ml ampoule. Oral liquid: 150 mg (as palmitate)/5 ml. Powder for injection: 1 g (sodium succinate) in vial. Ophthalmic drops 0.5%: 5mg/mL, 2.5mg/0.5mL Ophthalmic ointment 1%: 10mg/1gram
- Due to the rare toxicity of aplastic anaemia, chloramphenicol reserved for serious infections, especially H.influenzae meningitis, epiglottitis caused by ampicillin-resistant H.influenzae, and typhoid fever; rickettsial infections when tetracyclines are contraindicated.
- Ophthalmic surgery prophylaxis: Chloramphenicol 0.5% ophthalmic drops; instill 1 drop 2-4 hourly for 24 hours prior to surgery.
- Bacterial conjunctivitis: Chloramphenicol 1% ophthalmic drops, instill 1 drop 4-6 hourly during the day.
- Bacterial meningitis caused by sensitive strains of meningococcus, pneumococcus, and Haemophilus: chloramphenicol 1gm IV q6h.
Zambia Information Author: Paul A. Pham, Pharm. D.
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Brain abscess
- Paratyphoid fever
- Q fever
- Rocky mountain spotted fever and other Typhus infections caused by Rickettsia species
- Ehrlichiosis
- Meningitis
- Typhoid fever
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Lung abscess
- Gas gangrene (in PCN allergic pts)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Chloromycetin | Chloramphenicol | ~Monarch | IV
vial
1000mg | $7.90 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
250-500mg PO q6h (usual dose is 500 mg PO q6h, oral formulation unavailable in US); 50mg/kg IV in 4 divided doses (up to 100mg/kg/day).
Usual dose.
Usual dose.
Usual dose.
500 mg, dose post-dialysis.
Usual regimen.
Limited data; may be removed. Monitor serum concentrations.
- GI intolerance with oral administration.
- Bone marrow suppression (more likely with >4 grams per day or with serum level >25 mcg/ml).
- Fatal aplastic anemia (not dose related). Occurs at a rate of 1 per 40,000.
- "Gray baby syndrome" with cyanosis and circulatory collapse.
- Optic neuritis
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Peripheral neuropathy
- Fever
- Allergic reactions
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C. difficile colitis
- Vit B12: hematologic effects of Vit B12 in patients with pernicious anemia may be decreased.
- Rifampin: may decrease serum concentration of chloramphenicol.
- Sulfonylureas (chlorpropamide, tolbutamide): chloramphenicol may inhibit hepatic metabolism of some sulfonylureas resulting in prolongation of half-life and resultant hypoglycemia.
- Warfarin: may increase anticoagulant effect of warfarin. Monitor INR closely with co-administration.
- Iron supplements: chloramphenicol may inhibit heme synthesis, reduce iron clearance and increase serum iron level.
- Phenobarbital: may decrease chloramphenicol serum concentrations.
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Atazanavir: may increase chloramphenicol serum concentrations. Use with close monitoring for bone marrow suppression.
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Nelfinavir: may decrease chloramphenicol serum concentrations.
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Ritonavir: may decrease chloramphenicol serum concentrations.
Oral and parenteral broad spectrum drug that is infrequently used in the U.S. due to rare idiosyncratic toxicity of aplastic anemia (1:40,000) and the availability of alternative agents. May be used as a second line agent (with vancomycin) for the empiric treatment of bacterial meningitis in PCN-allergic patients. Oral formulation unavailable in U.S.
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