CHLORAMPHENICOL

Indications & Dose:

Typhoid fever. H. influenzae, meningitis. Other severe infections when careful clinical assessment indicates no other antibiotics effective. Eye infections,  anaerobic infections, ear infection. 

DOSE

Adults

By mouth or intravenous injections or infusion 50mg/ kg daily in 4 divided doses (expcetionally, can be doubled for severe infections such as septicaemia and meningitis, providing high doses reduced as soon as clinically indicated)

Child

Haemophilus epiglottitis and pyogenic meningitis, 50-100mg/kg daily in divided doses (high dosages decreased as soon as clinically indicated) 

Infants:
under 2 weeks 25mg/kg daily (in divided doses), 2 weeks-1 year 50mg/kg daily (in 4 divided doses). Note: plasma concentration monitoring required in neo-nates and preferred in those under 4 years of age; recommended peak plasma concentration (measured approx., 1 hour after intravenous injection or infusion), 15-25mg/litre; predose (trough) concentration should not exceed 15mg/litre. 

Contraindications:

Pregnancy & breast feeding, porphyria. Premature infants, trivial infections and hypersensitivity.

Side Effects:

Nausea, vomiting, epigastric distress, skin rash, gray baby syndrome, superinfection, aplastic anaemia, pancy-topenia, optic and peripheral neuritis. 

Cautions:

Aviod repeated courses and prolonged treatment, reduce doses in hepatic or renal impairment, blood counts required before and periodically during treatment may cause grey syndrome in neonates (monitor plasma concentrations)

Precautions:

Repetitive courses to be avoided, duration of therapy less than 2 to 3 weeks. Periodic blood counts. Not to be used in minor infections, and concomitantly with phenytoin, anticoagulants and sulfonylurea.

Old Age: May be used. 

Interaction:

Drugs

Dicoumarol, Phenytoin, Phenobarbital, Tolbutamide & Chlorpropa- mide: Efficacy enhanced when chloram-phenicol administered concomitantly since it inhibits the metabolism of these drugs.

Cyclophosphamide: Efficacy reduced.

Acetaminophen: Efficacy of Chloramphenicol potentiated leading to toxicity.

Iron salts and Vit. B12: Hematologic response decreased.

Penicillin: Decreases efficacy of penicillin and increases serum concentration of chloramphenicol.

Rifampicin: Reduces serum chloram phenicol levels (hepatic enzyme induction).

Tricyclic Anti-Depressants: Blood levels and adverse effects increased

 Mannitol & Hydrochlorothiazide: Increases renal excretion of chloramphenicol. 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: