Dosing
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. More common with the oral form.
Idiosyncratic: aplastic anemia.
Dose-related: cytopenias, grey baby.
Leukemia.
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
Follow CBC q 2 d and measure blood levels while on the drug
Treatment of choice
Side effects render this a last ditch antibiotics with allergies. I have used it one time in 30 years.
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.
Rickettsial infections, second or third line.
Don't use for
Class
Last Update: 08/27/19.