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.
For all information regarding contra-indications, interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).
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
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