University of Pennsylvania Medical Center Guidelines for Antibiotic Use

CHLORAMPHENICOL GUIDELINES

There is little information in the literature addressing chloramphenicol dosing and serum concentration monitoring in adults.  Serum concentrations above 25 mcg/ml have been associated with an increased rate of bone marrow toxicity.  Studies have not been done to show a correlation between trough levels and toxicity, and no studies to date have been able to show a correlation between levels and clinical efficacy and the development of resistance.   The following guidelines are based on what is known about the dosing of chloramphenicol for patients with multi-drug resistant enterococcal infections including neutropenic patients.

Initial chloramphenicol dosing:

1.  40 - 50 mg/kg/day in 3 - 4 divided doses for patients with normal renal and hepatic function  (**doses up to 100 mg/kg/day may be necessary in severe infections such as meningitis)

2.  30 - 35 mg/kg/day in 2 - 3 divided doses based on severity of hepatic and renal impairment

3.  PHARMACOKINETICS CONSULT is recommended for all patients receiving chloramphenicol

Monitoring chloramphenicol:

1.  Baseline CBC upon ordering chloramphenicol and then a minimum of 3 times per week.  If counts begin to decrease, then CBC should be monitored more frequently.

2.  Recommended trough levels are 5 -10 mcg/ml and peak levels between 15 - 20 mcg/ml.  If patient relapses or appears to be failing therapy, then the dose can be increased to achieve peaks of 21 - 25 mcg/ml   (**if dosing for higher levels, remember to closely monitor CBC for toxicity).

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