Chloramphenicol
CHLOROMYCETIN
Pronunciation: klor-am-FEN-i-kol
What it isInhibitor of the 50S ribosomal subunit; severe infection where alternatives are unavailable.
Why this oneExcellent CNS penetration and broad cover at very low cost, which keeps it in use globally.
What limits itIdiosyncratic aplastic anemia, and gray baby syndrome in neonates from immature glucuronidation.
FDA-approved for
- serious infections (~1950)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Serious infections caused by susceptible organisms (when less hazardous agents are ineffective or contraindicated) |
Renal Reduce dose; excessive blood levels may result from usual dose in renal impairment — adjust dose or monitor blood concentration
Hepatic Reduce dose; excessive blood levels may result from usual dose in hepatic impairment — adjust dose or monitor blood concentration
Instructions
- Reconstitute per directions to 100 mg/mL (1 g/10 mL) for IV administration
- Obtain baseline blood studies, then repeat approximately every 2 days during therapy; discontinue on reticulocytopenia, leukopenia, thrombocytopenia, anemia, or other blood findings
- Avoid repeated courses; do not continue longer than required to effect cure
Available strengths
- inj 1 g
Contraindications
- Trivial infections, colds, influenza, throat infections, or use as bacterial prophylaxis
Cautions
- Bone marrow depression / serious and fatal blood dyscrasias (may be irreversible; aplastic anemia has terminated in leukemia)
- Mandatory baseline and periodic (~every 2 days) blood studies; hospitalize for monitoring
- Avoid concurrent drugs that cause bone marrow depression
- Avoid repeated courses; limit duration to minimum needed
- Gray syndrome toxicity in premature/full-term neonates and infants
- Overgrowth of nonsusceptible organisms including fungi
- Dose adjustment needed in hepatic or renal impairment and in neonates/infants (immature metabolism)
Adverse reactions
- Blood dyscrasias: aplastic/hypoplastic anemia, thrombocytopenia, granulocytopenia, pancytopenia; paroxysmal nocturnal hemoglobinuria
- GI: nausea, vomiting, glossitis, stomatitis, diarrhea, enterocolitis
- Neurotoxic: headache, mild depression, mental confusion, delirium; optic and peripheral neuritis (long-term use)
- Hypersensitivity: fever, macular/vesicular rash, angioedema, urticaria, anaphylaxis; Herxheimer reactions (typhoid)
- Gray syndrome in neonates (abdominal distension, cyanosis, vasomotor collapse, death)
Pregnancy Category C; crosses placental barrier; no adequate human studies; use only if benefit justifies risk to fetus (Gray syndrome risk).
Lactation Excreted in human milk; decide whether to discontinue nursing or the drug given risk of serious adverse reactions in nursing infants.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 1 g | inj | per unit | not offered |
⚠ BOXED WARNING
- Serious and fatal blood dyscrasias