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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIBACTERIALS FOR SYSTEMIC USE › AMPHENICOLS › Amphenicols
chloramphenicol
J01BA01
Forms & Strengths
- Intravenous injection: 1 gram vial (powder for reconstitution)
- Ophthalmic ointment: 1%
- Ophthalmic solution: 0.5%
Adult Dosing
- Systemic infection: 50 to 100 mg/kg/day IV divided every 6 hours
- Maximum daily dose: 4 g/day unless directed by serum concentrations
- Ophthalmic: 1 to 2 drops in the affected eye(s) every 2 to 4 hours
Pediatric Dosing
- Neonates < 7 days old: 25 mg/kg IV once daily
- Full-term neonates > 7 days old (> 2 kg): 50 mg/kg/day IV divided every 12 hours
- Infants and children > 1 month: 50 to 75 mg/kg/day IV divided every 6 hours
Indications
- Life-threatening infections where safer antimicrobials are ineffective or contraindicated
- Bacterial meningitis caused by susceptible organisms
- Severe typhoid fever
- Superficial ocular infections involving susceptible microorganisms
Mechanism of Action
- Binds reversibly to the 50S ribosomal subunit of susceptible bacteria
- Inhibits bacterial protein synthesis by blocking the action of peptidyl transferase
- Bacteriostatic action against a wide range of gram-negative and gram-positive organisms
Contraindications
- Hypersensitivity to chloramphenicol
- Previous adverse bone marrow reaction or history of chloramphenicol-induced toxic bone marrow depression
- Minor infections or prophylaxis
- Use in neonates when safer alternatives are available (risk of gray baby syndrome)
Adverse Reactions
- Bone marrow suppression including aplastic anemia (dose-dependent and idiosyncratic)
- Gray baby syndrome in neonates (abdominal distension, cyanosis, vasomotor collapse)
- Hypersensitivity reactions (fever, rash, urticaria)
- Optic and peripheral neuritis associated with prolonged therapy
- Herxheimer reaction during treatment for typhoid fever
Drug Interactions
- Inhibits hepatic cytochrome P450 enzymes (CYP2C19 and CYP3A4)
- Increases serum concentrations and toxicity of phenytoin, warfarin, and oral hypoglycemics
- Bone marrow toxicity may be exacerbated when co-administered with other myelosuppressive agents
- Inducers like rifampin or phenobarbital may decrease chloramphenicol serum concentrations
Curated Content: Needs Vetting Before Put to Clinical Use