Gram-positive: Streptococcus spp., Staphylococcus spp., Enterococcus spp., Bacillus anthracis, Listeria monocytogenes
Gram-negative: Hemophilus influenzae, M. catarrhalis, N. meningitides, E. coli, P. mirabilis, Salmonella spp., Shigella spp., Stenotrophomonas maltophilia
Mechanism of Action:
Termination of polypeptide synthesis by binding to the bacterial 50S ribosomal subunit
Half-life: 3.2±1.0 (hr)
Volume of distribution: 0.81±0.18 hours
Total Clearance: 228±113.4 ml/min
Hematologic: irreversible aplastic anemia, myelosuppression, leukopenia,
Neurologic: optic neuritis, peripheral neuritis, mental status changes
GI: glossitis, stomatitis
Skin: rash, anaphylaxis
Other: gray baby syndrome
Infants < 1 week: 25mg/kg q 24 hours
Infants 1 – 4 weeks: 25mg/kg q 12 hours
Older children/adults: 50mg/kg/day divided q 6 hours
Severe infections (adults): 100mg/kg/day divided q 6 hours (max dose 4g/day)
Disease state based dosing:
Renal failure: Dosing adjustments not necessary (including hemodialysis and peritoneal dialysis)
Hepatic failure: No official recommendations exist, but dose adjustments based on serum levels may be necessary
Chloramphenicol is an inhibitor of the cytochrome P450 2C9 and 3A4 isoenzyme. Caution should be exercised and monitoring is suggested when concomitantly administering chloramphenicol with drugs that have substrates of these enzymes.
Category C: Risk unknown. Human studies inadequate.
LFTs and CBC with differential at baseline, then Reticulocyte count and CBC with differential twice weekly while on therapy. Also, serum iron levels. And serum concentrations should be monitored routinely.
Therapeutic: Culture and sensitivities, signs and symptoms of infection
Toxic: Reticulocytopenia, anemia, leukopenia, thrombocytopenia
Serum levels: 0.5 – 1.5 hours after IV dose, peak target is 10 – 25mg/L.
CHLOROMYCETIN (Pfizer – AUSTRALIA, SPAIN, CANADA, IRELAND, SOUTH AFRICE,
SWEDEN, MEXICO, FINLAND, USA, NEW ZEALAND, INDIA)