Chloramphenicol Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

  • See monitoring requirements
  • Must be approved by micro/ID
  • Unlicensed preparation
  • See under 'Dose' for adjustments required in renal or hepatic impairment

Available preparations

Chloramphenicol 1g vial

Reconstitution

Water for injection and Sodium chloride 0.9%

To produce a 10% solution add 9.2ml to 1g vial to produce a 1000mg in 10ml solution (ref 1)

Methods of intravenous administration

Slow intravenous injection

  • Administer over at least 3 minutes (ref 1)

See also further information

Dose in adults

Usual dose

  • Give a stat dose of 25mg/kg and contact micro/ID for further advice (ref 2)
  • Dose is 12.5mg/kg to 25mg/kg every six hours (ref 3,4)
  • Doses at the higher end of range (25mg/kg)are used for serious infections such as septicaemia and meningitis provided high doses are reduced as soon as clinically indicated
  • Maximum dose 4g daily (ref 4). Avoid repeated courses and prolonged treatment

Renal impairment

  • eGFR less than 10mL/min - use usual dose but use only if no alternative (ref 2)
  • Increased risk of bone marrow depression. Monitor closely.
  • See below re monitoring of levels (ref 3)

Hepatic impairment

  • Avoid if possible - increased risk of bone-marrow depression; consider reducing dose and monitor levels (but see below) (ref 3)

Monitoring

  • Baseline FBC required before and every two days during treatment as chloramphenicol can cause severe bone marrow depression
  • Serious and fatal blood dyscrasias (aplastic anaemia, hypoplastic anaemia, thrombocytopenia, granulocytopenia) have occurred after both short and long-term use
  • Note: an irreversible type of marrow depression leading to aplastic anaemia with a high rate of mortality can occur weeks or months after therapy (ref 5)
  • Plasma concentration monitoring recommended in the elderly and in hepatic and renal impairment - however, not routinely available
  • Recommended plasma concentration(ref 3)
    • Peak (2 hours after intravenous administration)10 to 25mg/L
    • Trough (just before dose is due) less than 15mg/L

Further information

  • If required, chloramphenicol can be added to either Sodium chloride 0.9% and given as an infusion over 15 to 60 minutes. The volume is determined by patient's fluid requirements (ref 1)

Storage

Store below 250C

References

UK SPC 14/10/2022 (assessed via Medusa)

1. Injectable medicines information guide downloaded from Medusa 15/04/2025

2. GAPP app guidelines

3. BNF accessed online 15/04/2025

4. Sanford antimicrobial app- accessed online 16th, April 2024

5. Martindale- downloaded via http://www.medicinescomplete.com 15/04/2025

Therapeutic classification

Antibiotic