Formulary
Chloramphenicol: Indications, Dosing, Side Effects and Interactions
Chloramphenicol is a potent broad-spectrum antibiotic.
MedNext Academy | 4 min read
Chloramphenicol: Indications, Dosing, Side Effects and Interactions
Chloramphenicol is a potent broad-spectrum antibiotic.
Drug action
Chloramphenicol is a potent broad-spectrum antibiotic.
Indications and dose
**Superficial eye infections**
- **Child** (To The Eye Using Eye Drop): Apply 1 drop every 2 hours, reduce frequency as infection is controlled and continue for 48 hours after healing, frequency is dependent on the severity of the infection. For less severe infection 3-4 times daily is generally sufficient.
- **Adult** (To The Eye Using Eye Drop): Apply 1 drop every 2 hours, reduce frequency as infection is controlled and continue for 48 hours after healing, frequency is dependent on the severity of the infection. For less severe infection 3-4 times daily is generally sufficient.
- **Child** (To The Eye Using Eye Ointment): Apply once daily, to be applied at night, once daily dosing to be used if eye drops are used during the day, alternatively apply 3-4 times a day, multiple daily dosing to be used if ointment is used alone.
- **Adult** (To The Eye Using Eye Ointment): Apply once daily, to be applied at night, once daily dosing to be used if eye drops are used during the day, alternatively apply 3-4 times a day, multiple daily dosing to be used if ointment is used alone.
**Bacterial infection in otitis externa**
- **Child** (To The Ear): Apply 2-3 drops 2-3 times a day.
- **Adult** (To The Ear): Apply 2-3 drops 2-3 times a day.
**Life threatening infections particularly those caused byHaemophilus influenzae,Typhoid fever**
- **Adult** (By Mouth, Or By Intravenous Injection, Or By Intravenous Infusion): Life threatening infections particularly those caused by Haemophilus influenzae , Typhoid fever 12.5 mg/kg every 6 hours, in exceptional cases dose can be doubled for severe infections such as septicaemia and meningitis, providing high doses reduced as soon as clinically indicated.
**Superficial eye infections for chloramphenicol**
- **Child** (To the eye using eye drop): Apply 1 drop every 2 hours, reduce frequency as infection is controlled and continue for 48 hours after healing, frequency is dependent on the severity of the infection. For less severe infection 3-4 times daily is generally sufficient.
- **Child** (To the eye using eye ointment): Apply once daily, to be applied at night, once daily dosing to be used if eye drops are used during the day, alternatively apply 3-4 times a day, multiple daily dosing to be used if ointment is used alone.
**Bacterial infection in otitis externa for chloramphenicol**
- **Child** (To the ear): Apply 2-3 drops 2-3 times a day.
**Life threatening infections particularly those caused by Haemophilus influenzae, Typhoid fever for chloramphenicol**
- **Child** (By mouth, or by intravenous injection, or by intravenous infusion): 12.5 mg/kg every 6 hours, dose may be doubled in severe infections such as septicaemia, meningitis and epiglottitis providing plasma-chloramphenicol concentrations are measured and high doses reduced as soon as indicated.
- **Neonate up to 14 days** (By intravenous injection): 12.5 mg/kg twice daily, doses should be checked carefully as overdosage can be fatal.
- **Neonate 14 days to 28 days** (By intravenous injection): 12.5 mg/kg 2-4 times a day, doses should be checked carefully as overdosage can be fatal.
**Cystic fibrosis for the treatment of respiratory Burkholderia cepacia infection resistant to other antibacterials for chloramphenicol**
- **Child** (By mouth, or by intravenous infusion, or by intravenous injection): (consult product literature).
Cautions
When used by ear Avoid prolonged use With intravenous use Avoid repeated courses and prolonged treatment With oral use Avoid repeated courses and prolonged treatment
Contraindications
With intravenous use Acute porphyrias With oral use Acute porphyrias
Side effects
Rare or very rare With parenteral use Aplastic anaemia (reversible or irreversible, with reports of resulting leukaemia) Frequency not known When used by ear Blood disorder; bone marrow depression When used by eye (topical) Angioedema; bone marrow disorders; eye stinging; fever; paraesthesia; skin reactions With oral use Bone marrow disorders; circulatory collapse; diarrhoea; enterocolitis; nausea; optic neuritis; oral disorders; ototoxicity; vomiting With parenteral use Agranulocytosis; bone marrow disorders; depression; diarrhoea; dry mouth; fungal superinfection; headache; nausea; nerve disorders; thrombocytopenic purpura; urticaria; vision disorders; vomiting Side-effects, further information Associated with serious haematological side-effects when given systemically and should therefore be reserved for the treatment of life-threatening infections.
Interactions
**Other interactions (1):**
- The concomitant administration of chloramphenicol with other drugs liable to depress bone marrow function should be avoided.
Pregnancy
With intravenous use or oral use: Manufacturer advises avoid; neonatal 'grey-baby syndrome' if used in third trimester. When used by eye: Avoid unless essential-no information on topical use but risk of 'neonatal grey-baby syndrome' with oral use in third trimester.
Breast feeding
With intravenous use or oral use: Manufacturer advises avoid; use another antibiotic; may cause bone-marrow toxicity in infant; concentration in milk usually insufficient to cause 'grey syndrome'. When used by eye: Avoid unless essential- theoretical risk of bone-marrow toxicity.
Hepatic impairment
With intravenous use or oral use: Manufacturer advises caution (increased risk of bone-marrow depression)-monitor plasma-chloramphenicol concentration. Dose adjustments With intravenous use or oral use: Manufacturer advises consider dose reduction.
Renal impairment
With intravenous use or oral use: Caution (increased risk of bone-marrow depression)-monitor plasma-chloramphenicol concentration. M Dose adjustments With intravenous use or oral use: Consider dose reduction. M
Medicinal forms
Capsule,Solution,Drops,Drops,Ointment
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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