Infectious Disease Compendium

Chloramphenicol (Chloromycetin®)

Dosing

CrCl Formula

CrCl > 80: 250 - 750 mg po q 6 h po or 250 mg iv q 6 h.

CrCl 80-50: no change

CrCl 50-10: no change

CrCl < 10: no change

Hemodialysis: no change

Peritoneal dialysis: no change

Important side effects

Aplastic anemia in 1in 40,000 cases. Idiosyncratic: aplastic anemia. Dose related: cytopenias, grey baby.

Important drug interactions

Antagonistic with both penicillin and cephalosporins, rifampin will decrease chloramphenicol levels by 90%. Other drugs with potential interactions include acetaminophen, chlorpropamide, cyanocobalamin, cyclophosphamide, cyclosporine, dicumarol, entacapone, fosphenytoin, glimepiride, iron, live typhoid vaccine, methotrexate, phenobarbital, phenytoin, rifampin, rifapentine, tacrolimus.

Rants and Screeds

Pearls

Treatment of choice

Use for

Meningitis when type 1 allergic reaction to penicillins. It is the secondary agent for bioterrorism from Anthrax: 50 to 100 milligrams/kg/day divided every 6 hours, Plague: pneumonic plague 25 milligrams/kilogram every 6 hours for 10 days, Tularemia: 15 milligrams/kilogram every 6 hours for 14 to 21 days.

Don't use for

Class