Chloramphenicol

Indications
 Oral
Bacterial meningitis
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Brain abscess
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Granuloma inguinale
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Anthrax
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Listeriosis
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Gas gangrene
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Whipple's disease
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Severe systemic infections with Camphylobacter fetus
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Infections caused by H. influenzae
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Ehrlichiosis
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Severe gastroenteritis
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Severe melioidosis
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Plague
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Psittacosis
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Q fever
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Anaerobic bacterial infections
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Oral
Tularaemia
Adult: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections due to moderately resistant organisms. Continue treatment after the patient's temperature has normalised for a further 4 days in rickettsial disease and 8-10 days in typhoid fever.
Child: Premature and full-term neonates: 25 mg/kg/day in 4 divided doses. Full-term infants >2 wk: 50 mg/kg/day in 4 divided doses. Children: 50 mg/kg/day in 4 divided doses increased to 100 mg/kg/day for meningitis or severe infections.
Elderly:
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Ophthalmic
Ocular infections
Adult: Instill 1 drop of a 0.5% solution every 2 hr. Increase dosage interval upon improvement. To continue treatment for at least 48 hr after complete healing. Reduce dose once symptoms are controlled or apply a 1% ointment 3-4 times daily.
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Otic/Aural
Otitis externa
Adult: Instill 2-3 drops of a 5% solution into the ear bid-tid.
Renal impairment: Dose reduction may be required.
Hepatic impairment: Dose reduction may be required.
Contraindications
 History of hypersensitivity or toxic reaction to the drug; pregnancy, lactation; porphyria; parenteral admin for minor infections or as prophylaxis; preexisting bone marrow depression or blood dyscrasias.
Warnings / Precautions
 Impaired renal or hepatic function; premature and full-term neonates. Monitor plasma concentrations to avoid toxicity.
Adverse Reactions
 GI symptoms; bleeding; peripheral and optic neuritis, visual impairment, blindness; encephalopathy, confusion, delirium, mental depression, headache. Haemolysis in patients with G6PD deficiency. ophthalmic application: Hypersensitivity reactions including rashes, fever and angioedema. Ear drops: Ototoxicity.
Potentially Fatal: Bone marrow suppression and irreversible aplastic anaemia. Neutropenia, thrombocytopenia. Grey baby syndrome. Rarely, anaphylaxis.
Drug Interactions
 Decreased effects of iron and vitamin B12 in anaemic patients. Phenobarbitone and rifampin reduce efficacy of chloramphenicol. Impairs the action of oral contraceptives.
Potentially Fatal: Increases the effect of oral anticoagulants, oral hypoglycaemic agents, phenytoin. Avoid concomitant administration with drugs that depress bone marrow function.
See Below for More chloramphenicol Drug Interactions
Mechanism of Actions
 Chloramphenicol inhibits bacterial protein synthesis by binding to 50s subunit of the bacterial ribosome, thus preventing peptide bond formation by peptidyl transferase. It has both bacteriostatic and bactericidal action against H. influenzae, N. meningitidis and S. pneumoniae.
Duration: Typhoid: 8-10 days; meningitis: 7-10 days; brain abscess: Up to 4 wk.
Absorption: Readily absorbed with peak plasma concentrations after 1 or 2 hr (oral).
Distribution: Distributed widely into tissues and fluids, CSF (up to 50% even in the absence of meningitis), eye (aqueous and vitreous humours); crosses the placenta and enters the breast milk. Protein-binding: 60%.
Metabolism: Hydrolysed to the free drug in the GI tract (palmitate); liver by conjugation with glucuronic acid, lungs and kidneys after parenteral admin (sodium succinate).
Excretion: Via the urine (30% as unchanged before hydrolysis, 5-10% of an oral dose), via the bile (3%), via the faeces (1% as inactive form); 1.5-4 hr (elimination half-life).
Administration
 Should be taken on an empty stomach. (Take on an empty stomach 1 hr before or 2 hr after meals.)
Storage Conditions
 Ophthalmic: Refrigerate at 2-8°C. Do not freeze. Oral: Store at 15-25°C. Otic/Aural: Refrigerate at 2-8°C. Do not freeze.
ATC Classification
 D06AX02 - chloramphenicol ; Belongs to the class of other topical antibiotics used in the treatment of dermatological diseases.
D10AF03 - chloramphenicol ; Belongs to the class of topical antiinfective preparations used in the treatment of acne.
G01AA05 - chloramphenicol ; Belongs to the class of antibiotics. Used in the treatment of gynecological infections.
J01BA01 - chloramphenicol ; Belongs to the class of amphenicols. Used in the systemic treatment of infections.
S01AA01 - chloramphenicol ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
S02AA01 - chloramphenicol ; Belongs to the class of antiinfectives used in the treatment of ear infections.
S03AA08 - chloramphenicol ; Belongs to the class of antiinfectives used in ophthalmologic and otologic preparations.
Storage
 Ophthalmic: Refrigerate at 2-8°C. Do not freeze. Oral: Store at 15-25°C. Otic/Aural: Refrigerate at 2-8°C. Do not freeze.
Available As
  • Chloramphenicol 0.1%
  • Chloramphenicol 0.1% w/v
  • Chloramphenicol 0.2%
  • Chloramphenicol 0.4%
  • Chloramphenicol 0.4% w/v
  • Chloramphenicol 0.5%
  • Chloramphenicol Palmitate 0.5% w/v
  • Chloramphenicol 0.5% w/v
  • Chloramphenicol Palmitate 0.50% w/v
  • Chloramphenicol 0.55%
  • Chloramphenicol Maleate 1 mg
  • Chloramphenicol 1%
  • Chloramphenicol 1% w/v
  • Chloramphenicol 1% w/w
  • Chloramphenicol 1.0%
  • Chloramphenicol 1.0% w/v
  • Chloramphenicol 1.1%
  • Chloramphenicol 10 mg
  • Chloramphenicol Sodium 1000 mg
  • Chloramphenicol 1000 mg
  • Chloramphenicol Sodium Succinate 1000 mg
  • Chloramphenicol Palmitate 125 mg
  • Chloramphenicol 125 mg
  • Chloramphenicol Maleate 2 mg
  • Chloramphenicol 250 mg
  • Chloramphenicol 31.25 mg
  • Chloramphenicol Maleate 4 mg
  • Chloramphenicol 4 mg
  • Chloramphenicol 5 mg
  • Chloramphenicol 5%
  • Chloramphenicol 5% w/v
  • Chloramphenicol 5% w/w
  • Chloramphenicol 500 mg
  • Chloramphenicol 90 mg

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