Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • today, chloramphenicol is a rarely used wide spectrum antibiotic whose use is essentially restricted to the treatment of infections caused by organisms which are resistant to safer antibiotics (eg. may be used to treat CNS infections, such as brain abscesses, with proven penicillin resistant pneumococci)
  • should not be used as primary therapy


  • chloramphenicol succinate (parenteral) and chloramphenicol palmitate (oral suspension) must first be hydrolyzed to the free base, chloramphenicol, to be biologically active
  • the degree of hydrolysis is unpredictable and can vary from patient to patient
  • the free base, chloramphenicol, is inactivated by hepatic glucuronyl transferase; up to 90% of chloramphenicol is renally excreted as the glucuronide
  • chloramphenicol appears to inhibit protein synthesis by binding to 50S ribosomal subunits in the cell of susceptible organisms
  • chloramphenicol distributes widely into most body tissues and fluids, including the CNS
  • it has been suggested that peak serum levels should be between 10 and 25 ug/mL, in order to maximize efficacy and minimize toxicity

Side Effects

  • bone marrow suppression (non-dose related, irreversible and dose related, reversible)
  • gray baby syndrome (circulatory collapse, abdominal distention, pallour; cyanosis, may lead to death within hours); has been associated with peak serum concentration greater than 50 ug/mL


  • serum concentrations must be monitored; the peak serum levels should be 10 to 25 mcg/mL


  • give by slow IV infusion or po. DO NOT give IM (ineffective by this route)

    < 2,000 g0 - 28 days25 mg/kgq24h
    > 2,000 g< 7 days
    7 to 28 days
    25 mg/kg
    25 mg/kg
  • if a decision is made to use chloramphenicol, serum concentrations MUST be monitored; dosages must be adjusted to maintain the peak serum level 10 to 25 mcg/mL


  • 1 g vial; when reconstituted with 10mL (for Chloromycetin(R) brand) sterile water for injection produces a final concentration of 100 mg/mL which may be injected into a running IV and given by slow infusion


  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  3. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  4. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.

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