Central nervous system chloramphenicol concentration in premature infants

Four premature infants under 1,500 g were treated with parenteral chloramphenicol for central nervous system infections due to organisms resistant to the penicillins. Serum, cerebrospinal fluid (CSF), and ventricular fluid concentrations of chloramphenicol were measured frequently during therapy and were used to maintain drug dosages in the safe and therapeutic range. Concentrations of chloramphenicol in the lumbar CSF and ventricular fluid had a mean of 23.3 +/- 7.7 micrograms/ml, consistently greater than 45% of peak serum levels. These data show that chloramphenicol enters the CSF in both ventricular and lumbar regions in therapeutic concentrations when administered intravenously. The clinical usefulness of this drug remains to be investigated. The importance of monitoring serum drug levels during therapy is emphasized.