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Chloramphenicol: new perspectives on an old drug

D A Powell, M C Nahata

    Drug Intelligence & Clinical Pharmacy
    |April 1, 1982
    PubMed

    Insights

    Chloramphenicol use is rising for childhood infections. New pharmacokinetic data highlight variable bioavailability and clearance, necessitating careful dosing based on age and serum levels to avoid toxicity.

    Area of Science:

    • Pharmacology
    • Infectious Diseases
    • Pediatrics

    Background:

    • Chloramphenicol is experiencing a resurgence in treating serious childhood infections, particularly those caused by ampicillin-resistant Hemophilus influenzae type b.
    • Increased clinical use and advanced analytical methods have spurred recent investigations into chloramphenicol and its prodrug esters.

    Purpose of the Study:

    • To review current pharmacokinetic data on chloramphenicol and its prodrugs, chloramphenicol succinate and chloramphenicol palmitate.
    • To emphasize the clinical implications of these pharmacokinetic findings in light of chloramphenicol's toxicity profile.

    Main Methods:

    • Review of recent literature on chloramphenicol pharmacokinetics.
    • Analysis of bioavailability data for chloramphenicol succinate and chloramphenicol palmitate.
    • Examination of interpatient variability in chloramphenicol clearance.

    Main Results:

    • Incomplete bioavailability of chloramphenicol succinate was observed.
    • Chloramphenicol palmitate may offer superior bioavailability compared to chloramphenicol succinate.
    • Significant interpatient variability in chloramphenicol clearance was documented.

    Conclusions:

    • Pharmacokinetic variability necessitates individualized chloramphenicol dosing.
    • Age-based initial dosing and therapeutic drug monitoring of peak serum concentrations are crucial.
    • Careful patient monitoring is essential due to the risk of serious hematologic and metabolic toxicities.

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