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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Chloramphenicol

Paul A. Pham Pharm.D. and Johns G. Bartlett M.D.
10-10-2010

Zambia Specific Information

  • Available formulation in Zambia: Capsule: 250 mg. Oily suspension for injection: 0.5 g (as sodium succinate)/ml in 2 ml ampoule. Oral liquid: 150 mg (as palmitate)/5 ml. Powder for injection: 1 g (sodium succinate) in vial. Ophthalmic drops 0.5%: 5mg/mL, 2.5mg/0.5mLOphthalmic ointment 1%: 10mg/1gram
  • Due to the rare toxicity of aplastic anaemia, chloramphenicol reserved for serious infections, especially H.influenzae meningitis, epiglottitis caused by ampicillin-resistant H.influenzae, and typhoid fever; rickettsial infections when tetracyclines are contraindicated.
  • Ophthalmic surgery prophylaxis: Chloramphenicol 0.5% ophthalmic drops; instill 1 drop 2-4 hourly for 24 hours prior to surgery.
  • Bacterial conjunctivitis: Chloramphenicol 1% ophthalmic drops, instill 1 drop 4-6 hourly during the day.
  • Bacterial meningitis caused by sensitive strains of meningococcus, pneumococcus, and Haemophilus: chloramphenicol 1gm IV q6h.

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Note: use only in those serious infections for which less potentially dangerous drugs are ineffective or contraindicated.
  • Acute infections caused by Salmonella typhi
  • Serious infections caused by Salmonella species, H. influenzae, specially meningeal infections, Rickettsia, Lymphogranuloma-psittacosis Chlamydia group, various gram-negative bacteria causing bacteremia and meningitis.
  • Part of a cystic fibrosis regimen when other agents are ineffective or contraindicated.
  • Ocular infections (ophthalmic drops and ointments)
NON-FDA APPROVED USES

  • Lung abscess
  • Gas gangrene (in PCN allergic pts)
  • Brain abscess
  • Paratyphoid fever
  • Q fever (Coxiella burnetii)
  • Rocky mountain spotted fever and other endemic (murine or scrub) typhus infections caused by Rickettsia species
  • Ehrlichiosis
  • Meningitis in PCN-allergic patients.

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
ChloromycetinChloramphenicol ~MonarchIV
vial
1000mg
$28.74
Chloramphenicol Chloramphenicol Various non-U.S. manufacturer PO
capsule
250 mg
n/a
      ophthalmic
ophthalmic solution
0.5%
n/a
      ophthalmic
ophthalmic ointment
1%
n/a

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

  • 50mg/kg IV in 4 divided doses (up to 100mg/kg/day).
  • 250-500mg PO q6h (usual dose is 500 mg PO q6h (oral formulation unavailable in U.S.).
  • S. typhi: Administer for 8 to 10 days after the patient has become afebrile to decrease relapse rate.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Usual dose. Monitor serum concentrations.

DOSING IN HEMODIALYSIS

Usual dose + 500 mg, dose post-dialysis. Monitor serum concentrations.

DOSING IN PERITONEAL DIALYSIS

Usual regimen.

DOSING IN HEMOFILTRATION

Limited data; may be removed. Monitor serum concentrations.

ADVERSE DRUG REACTIONS

OCCASIONAL

  • GI intolerance with oral administration.
  • Bone marrow suppression (more likely with >4 grams per day or with serum level >25 mcg/ml).
RARE

  • Fatal aplastic anemia (not dose related). Occurs at a rate of 1 per 40,000.
  • "Gray baby syndrome" with cyanosis and circulatory collapse.
  • Optic neuritis
  • Peripheral neuropathy
  • Fever
  • Allergic reactions
  • C. difficile colitis

DRUG INTERACTIONS

  • HIV protease inhibitors (e.g. atazanavir,  indinavir) : may increase chloramphenicol serum concentrations. Use with close monitoring for bone marrow suppression.
  • Phenobarbital: may decrease chloramphenicol serum concentrations.
  • Rifampin: may decrease serum concentration of chloramphenicol.
  • Sulfonylureas (chlorpropamide, tolbutamide):chloramphenicol may inhibit hepatic metabolism of some sulfonylureas resulting in prolongation of half-life and resultant hypoglycemia.
  • Vitamin B12: hematologic effects of Vit B12 in patients with pernicious anemia may be decreased.
  • Warfarin: may increase anticoagulant effect of warfarin. Monitor INR closely with co-administration.

SPECTRUM

Detailed Spectrum of Activity

PHARMACOLOGY

Pharmacology

COMMENTS

Oral and parenteral broad spectrum drug that is infrequently used in the U.S. due to rare idiosyncratic toxicity of aplastic anemia (1:40,000, more commonly associated with oral administration) and the availability of alternative agents. May be used as a second line agent (with vancomycin) for the empiric treatment of bacterial meningitis in PCN-allergic patients. Oral formulation unavailable in U.S.

REFERENCES

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