Dose:     25 mg/kg/dose IV, PO

Frequency: Q 24 hours if < 2 week
                     Q 24 hours if < 42 weeks PCA
                     Q 12 hours if  > 42 weeks PCA
                      Dose Adjustment for renal failure or hepatic insufficiency 

Indications: Chloramphenicol is effective against most gram positive anaerobic and aerobic bacteria (including Staph. aureus and clostridia. U. urealyticum is also usually sensitive. A number of gram negative bacteria are also sensitive including Neisseria species, L. monocytogenes, E. coli, Klebsiella, B. fragilis, H. influenza, salmonella, and proteus. Group D streptococcus, Enterobacter, Serratia, Pseudomonas, and indole positive proteus are resistant.  The use of cefotaxime or cefotaxime with chloramphenicol have been shown to be antagonistic in vitro.  Because of significant risks of toxicity, serum levels must be maintained between 10 and 25 mcg/ml. Further comments on chloramphenicol including an alternative method of administration.

Toxicity:   The principal toxicities involve two distinct forms of bone marrow suppression, one resulting in the clinical entity known as the "Gray baby" syndrome.  Keeping trough levels below 25 mcg/ml minimizes the chance of this occurring. Adverse reactions associated with chloramphenicol.

Preparation:
PO: Chloramphenicol (Chloromycetin) is available as 150 mg/5ml preparation. Shake well before using. Store at room temperature.

IV: Chloramphenicol (Chloromycetin) is available in a 1 gram vial. To prepare a 100 mg/ml concentration, add 10 ml sterile water for injection to the   1 gram vial. Infuse over thirty minutes. Refrigerate. Reconstituted vial stable 24 hours.

Compatibility: Compatible with filter and TPN as well as D5W, D5 with sodium chloride, D10, LR, 0.45% sodium chloride, and NS.  Compatible with acyclovir, amikacin, aminophylline, ampicillin, calcium gluconate, dopamine, enalaprilat, esmolol, fat emulsion 10%, heparin, hydrocortisone, kanamycin, labetalol, lidocaine, magnesium sulfate, methicillin, metronidazole, morphine, nafcillin, penicillin G sodium and potassium, phenobarbital, phytonadione, potassium chloride,   ranitidine, and sodium bicarbonate.  Incompatible with fluconazole, glycopyrrolate, metoclopramide, phenytoin, and vancomycin.  Chloramphenicol has equivocal compatibility with erythromycin lactobionate and methicillin.