Chloramphenicol

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

Oral/IV: 50 mg/kg/day in divided doses every 6 hours (maximum 100 mg/kg/day)

PHARMACOKINETICS

Molecular weight :323.1

%Protein binding :60

%Excreted unchanged in urine : 5–10

Volume of distribution (L/kg) :0.5–1.0

half-life – normal/ESRD (hrs) :1.5–4/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Dialysed. Dose as in normal renal function

HDF/high flux :Dialysed. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anticoagulants: effect of coumarins enhanced

Antidiabetics: effect of sulphonylureas enhanced

Anti-epileptics: metabolism accelerated by barbiturates and primidone (reduced plasma concentration of chloramphenicol); increased plasma concentration of phenytoin (risk of toxicity

)Antipsychotics: avoid concomitant use with clozapine (increased risk of agranulocytosis)

Ciclosporin: possibly increases ciclosporin concentration

Tacrolimus: possibly increases tacrolimus concentration

ADMINISTRATION

Reconstition

Kemicetine: 1 g vial – reconstitute with water for injection, sodium chloride 0.9% or glucose 5%. 1.7 mL = 400 mg/mL solution 3.2 mL = 250 mg/mL solution 4.2 mL = 200 mg/mL solution

Route

Oral, IV, IM (Kemicetine only)

Rate of Administration

Over at least 1 minute

Comments

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OTHER INFORMATION

Manufacturers recommend monitoring serum levels in patients with renal impairment – Micromedex therapeutic range 10–25 micrograms/mL

Levels should be taken 1 hour after IV administration, aim for 15–25 mg/L, trough <15 mg/L

Kemicetine 1 g vial = 3.14 mmol sodium .

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