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Chloramphenicol
Chloramphenicol (Chloromycetin)
Chloramphenicol
(klor-am-
FEN-ih-kohl)
Chloromycetin (Cream and Otic)
Mychel
Pentamycetin
PMS-Chloramphenicol
(Rx)
Chloramphenicol ophthalmic
Chloramphenicol ophthalmic (Chloromycetin Ophthalmic)
Chloramphenicol
(klor-am-
FEN-ih-kohl)
AK Chlor
Chloromycetin Ophthalmic
Chloroptic Ophthalmic
Chloroptic S.O.P. Ophthalmic
Diochloram
Ophtho-Chloram
(Rx)
Chloramphenicol sodium succinate
Chloramphenicol sodium succinate (Chloromycetin Sodium Succinate)
Chloramphenicol
(klor-am-
FEN-ih-kohl)
Chloromycetin Injection
Chloromycetin Sodium Succinate
Mychel-S
Novo-Chorocap
(Rx)
Classification:
Anti-infective
See Also:
See also
Anti-Infectives
[.
]
Action/Kinetics:
Interferes with or inhibits protein synthesis in bacteria by binding to 50S ribosomal subunits. Therapeutic serum concentrations:
peak 10-20 mcg/mL;
trough: 5-10 mcg/mL (less for neonates).
Peak serum concentration: IM, 2 hr.
t
1/2: 4 hr. Metabolized in the liver; 75%-90% excreted in urine within 24 hr, as parent drug (8%-12%) and inactive metabolites. Mostly bacteriostatic. Well absorbed from the GI tract and distributed to all parts of the body, including CSF, pleural, and ascitic fluids; saliva; milk; and aqueous and vitreous humors.
Uses:
Not to be used for trivial infections, prophylaxis of bacterial infections, or to treat colds, flu, or throat infections.
Systemic Use. Treatment of choice for typhoid fever but not for typhoid carrier state. Serious infections caused by
Salmonella, Rickettsia, Chlamydia and lymphogranuloma-psittacosis group. Meningitis due to
Haemophilus influenzae. Brain abscesses due to
Bacteroides fragilis. Cystic fibrosis anti-infective. Meningococcal or pneumococcal meningitis.
Topical Use. Otitis externa. Prophylaxis of infection in minor cuts, wounds, skin abrasions, burns; promote healing in superficial infections of the skin.
Ophthalmic Use. Superficial ocular infections due to
Staphylococcus aureus; Streptococcus species, including
S. pneumoniae;
Escherichia coli, H. influenzae, H. aegyptius, H. ducreyi, Klebsiella species,
Neisseria species,
Enterobacter species,
Moraxella species, and
Vibrio species. Use only for serious ocular infections for which less dangerous drugs are either contraindicated or ineffective.
Contraindications:
Hypersensitivity to chloramphenicol; pregnancy, especially near term and during labor; lactation. Avoid simultaneous administration of other drugs that may depress bone marrow. Ophthalmically in the presence of dendritic keratitis, vaccinia, varicella, mycobacterial or fungal eye infections, or following removal of a corneal foreign body. Topical products should not be used near or in the eye.
Special Concerns:
Use with caution in clients with intermittent porphyria or G6PD deficiency. To avoid gray syndrome, use with caution and in reduced doses in premature and full-term infants. Ophthalmic ointments may retard corneal epithelial healing.
Side Effects:
Hematologic (most serious):
Aplastic anemia, hypoplastic anemia thrombocytopenia, granulocytopenia,
hemolytic anemia pancytopenia, hemoglobinuria (paroxysmal nocturnal).
Hematologic studies should be undertaken before and every 2 days during therapy.
GI: N&V;, diarrhea, glossitis, stomatitis, unpleasant taste, enterocolitis, pruritus ani.
Allergic: Fever, angioedema, macular and vesicular rashes, urticaria, hemorrhages of the skin, intestine, bladder, mouth.
Anaphylaxis.
CNS: Headache, delirium, confusion, mental depression.
Neurologic: Optic neuritis, peripheral neuritis.
Following topical use: Burning, itching, irritation, redness of skin. Hypersensitive clients may exhibit
angioneurotic edema urticaria, vesicular and maculopapular dermatoses.
Miscellaneous: Superinfection. Jaundice (rare). Herxheimer-like reactions when used for typhoid fever (may be due to release of bacterial endotoxins).
Gray syndrome in infants: Rapid respiration, ashen gray color, failure to feed, abdominal distention with or without vomiting, progressive pallid cyanosis, vasomotor collapse, death. Can be reversed when drug is discontinued.
NOTE: Neonates should be observed closely, since the drug accumulates in the bloodstream and the infant is thus subject to greater hazards of toxicity.
After ophthalmic use: Temporary blurring of vision, stinging, itching, burning, redness, irritation, swelling, decreased vision, persistent or worse pain.
Drug Interactions:
-
Acetaminophen /
 Effect of chloramphenicol due to
serum levels
-
Anticoagulants, oral /
Anticoagulant effect due to
 liver breakdown
-
Antidiabetics, oral /
Hypoglycemic effect due to
liver breakdown
-
Barbiturates /
Barbiturate effect due to
liver breakdown; also,
serum levels of chloramphenicol
-
Chymotrypsin / Chloramphenicol will inhibit chymotrypsin
-
Cyclophosphamide / Delayed or
activation of cyclophosphamide
-
Iron preparations /
Serum levels
-
Penicillins / Either
or
effect when combined to treat certain microorganisms
-
Phenytoin /
Phenytoin effect due to
liver breakdown; also, chloramphenicol levels may be
or
-
Rifampin /
Chloramphenicol effect due to
liver breakdown
-
Tacrolimus /
Tacrolimus blood levels due to
liver breakdown
-
Vitamin B
12 /
Vitamin B
12 response when treating pernicious anemia
How Supplied:
Chloramphenicol ophthalmic:
Ointment: 1%;
Powder for reconstitution: 25 mg;
Solution: 0.5%
Chloramphenicol sodium succinate:
Powder for injection: 1 g
Dosage
?IV: Chloramphenicol
Adults: 50 mg/kg/day in four equally divided doses q 6 hr. Can be increased to 100 mg/kg/day in severe infections, but dosage should be reduced as soon as possible.
Neonates and children with immature metabolic function: 25 mg/kg once daily in divided doses q 12 hr.
Neonates, less than 2 kg: 25 mg/kg once daily.
Neonates, over 2 kg, over 7 days of age: 50 mg/kg/day q 12 hr in divided doses.
Neonates, over 2 kg, from birth to 7 days of age: 50 mg/kg once daily.
Children: 50-75 mg/kg/day in divided doses q 6 hr (50-100 mg/kg/day in divided doses q 6 hr for meningitis).
NOTE: Carefully follow dosage for premature and newborn infants less than 2 weeks of age because blood levels differ significantly from those of other age groups.
?Chloramphenicol Sodium Succinate--IV Only
Same dosage as chloramphenicol (see the preceding). Switch to
PO as soon as possible.
?Chloramphenicol Ophthalmic Ointment 1%
0.5-in. ribbon placed in lower conjunctival sac q 3-4 hr for acute infections and b.i.d.-t.i.d. for mild to moderate infections.
?Chloramphenicol Ophthalmic Solution 0.5%
1-2 gtt in lower conjunctival sac 2-6 times/day (or more for acute infections).
?Chloramphenicol Otic Solution 0.5%
2-3 gtt in ear t.i.d.
?Chloramphenicol Topical Cream 1%
Apply 1-4 times/day. |
