Chloramphenicol
Mechanism :
Chloramphenicol exerts mainly a bacteriostatic effect on a wide range of gram-negative and gram-positive bacteria and is active against rickettsia, the lymphogranuloma-psittacosis group, Salmonella typhi, Vibrio cholerae and Hemophilus influenzae. The mode of action is through interference or inhibition of protein synthesis in intact cells.
Indication :
- Typhoid
- Meningitis
- Conjunctivitis
- Septicemia
- External otitis
- Rickettsia fevers
Contraindications :
Chloramphenicol is contraindicated in individuals with a history of previous hypersensitivity and/or toxic reaction to it. It must not be used in the treatment of trivial infections or where it is not indicated, as in colds, influenza, infections of the throat.
Dosing :
Neonates:
Initial loading dose of 20 mg/kg IV once, followed by maintenance doses 12 hourly.
Infants and children:
(adult doses)
In case adequate CSF concentration required, 100 mg/kg/day; to be reduced to 50 mg/kg/day as soon as possible. In suspected immature metabolic functions: 25 mg/kg/day in in 6 hourly divided doses.
Adverse Effect :
Serious and fatal blood dyscrasias, like aplastic anemia, hypoplastic anemia, thrombocytopenia and granulocytopenia, nausea, vomiting, glossitis and stomatitis, diarrhea, enterocolitis, headache, mild depression, mental confusion, delirium, optic and peripheral neuritis, fever, macular and vesicular rashes, angioedema, urticaria, anaphylaxis, Grey baby syndrome.
Interaction :
Warfarin, Phenytoin and Sulphonylureas: Increased plasma levels of these drugs.
Phenobarbital and Rifampicin: Decrease chloramphenicol levels.
Chloramphenicol: Antagonistic to beta-lactam antibiotics, including ceftazidime.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Dialysed. Dose as in normal renal function |
| HDF/High flux | Dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
Chloramphenicol is metabolized by the liver. Dose reduction may be needed. However, specific dosage adjustment guidelines are not available.