Chloramphenicol
General Information
Class: amphenicol
This monograph is for INTRAVENOUS and ORAL chloramphenicol. It does not apply to the use of chloramphenicol eyedrops or ointment.
Restricted formulary antimicrobial: For details see OUH netFormulary
AWaRe antibiotic classification: 'Watch'. Use as per guidelines. All other indications to be discussed with Micro/ID.
Dosage
| PO | IV | |
| Standard dose |
12.5mg/kg QDS. Maximum 1g QDS. (Round to the nearest 250mg) |
12.5mg/kg QDS. Maximum 1g QDS. |
| Meningitis dose | Oral treatment not recommended. |
2g QDS (for 24 - 48 hours only, then reduce to standard dose.) |
Obesity
Dose using adjusted body weight (AdjBW) if the patient’s total body weight (TBW) is greater than 20% over ideal body weight (IBW).
- AdjBW= IBW + 0.4 x (TBW– IBW)
Renal and Hepatic impairment
Renal impairment
|
GFR (mL/min/1.73m2) |
Dose (PO and IV) |
|
More than 20 |
Dose as in normal renal function |
|
Less than 20 |
Dose as in normal renal function. Monitor plasma levels. |
|
HD/HDF/High Flux |
Dose as in normal renal function. Monitor plasma levels. Dialysed; give after dialysis. |
|
PD |
Dose as in normal renal function. Monitor plasma levels. Not dialysed. |
Hepatic impairment
- Avoid if possible: increased risk of bone-marrow suppression.
- If administration is required for greater than 48 hours, monitor levels and adjust dose (see below).
- Half-life is prolonged in patients with severe hepatic impairment. These patients may achieve excessive blood concentrations.
Monitoring
Haematology and Biochemistry
- Baseline FBC, LFTs and U&Es
- Week 1 – FBC every 2-3 days. Increase frequency if acutely unwell.
- After Week 1 – FBC weekly. U&Es/LFTs every 2 weeks.
- Delayed blood dyscrasias may occur after the course is completed.
Therapeutic Drug Monitoring
- Only to be commenced following advice of Micro/ID. (send-away test to the Bristol Reference Lab).
- Indications: treatment duration greater than 48 hours, especially in patients greater than 65 years old, or who have liver disease, obesity, or have drug-drug interactions.
- If in range, repeat weekly.
- Reference ranges:
- Trough: ideally less than 10mg/L but must be less than 15mg/L
- Peak (2 hours post dose): 10-25mg/L
Pregnancy and breastfeeding
Pregnancy
Avoid. Discuss with pharmacy if benefits outweigh risks. May result in grey-baby syndrome if administered in the third trimester.
Breastfeeding
Avoid. Discuss with pharmacy if benefits outweigh risks. Theoretical risk bone marrow suppression, grey-baby syndrome.
Additional information
Severe adverse effects include aplastic anaemia and bone marrow suppression. Fever and rash are also side effects.
References
1. Scottish Antimicrobial Prescribing Group. Chloramphenicol Prescribing in Adult Patients- Consensus Guidance. Published April 2021. Available at:
chloramphenicol-prescribing-in-adults.pdf (sapg.scot). Accessed on 13th June 2023.
2. Sanford Guide: Web edition. Chloramphenicol. Published October 2020. Available at: webedition.sanfordguide.com/en/drug-information/antibacterial-agents/chloramphenicol . Accessed on 13th June 2023.
3. Essential Pharma Ltd. Summary of Product Chracteristics: Chloramphenicol 1g Powder for Injection. Published July 2020. Available at: medicines.org.uk/emc/product/12869/smpc#gref Accessed on: 13th June 2023.
4. British National Formulary. Chloramphenicol. Available at: bnf.nice.org.uk/drugs/chloramphenicol . Accessed on: 13th June 2023.
5. UK Teratology Information Service. Use of Chloramphenicol in Pregnancy. Published April 2023. Available at: uktis.org/monographs/use-of-chloramphenicol-in-pregnancy/ Accessed on: 13th June 2023.
6. Specialist Pharmacy Services. Using chloramphenicol during breastfeeding. Published April 2023. Available at sps.nhs.uk/articles/using-chloramphenicol-during-breastfeeding/ Accessed on: 13th June 2023.
7. North Bristol NHS Trust. Test Information: Chloramphenicol. Available at: nbt.nhs.uk/severn-pathology/requesting/test-information/chloramphenciol. Accessed on: 13th June 2023.
8. Martindale:The Complete Drug Reference. Chloramphenciol. Available at: medicinescomplete.com/#/content/martindale/49-p?hspl=chloramphenicol Accessed on: 13th June 2023
9. European Committee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs and zone diameters. Published January 2023. Available at: eucast.org/clinical_breakpoints Accessed on 13th June 2023