• IV: Management of the following serious infections when less toxic agents cannot be used:
  • Skin and soft-tissue infections,
  • Intra-abdominal infections,
  • CNS infections (including meningitis),
  • Bacteremia.

Contraindicated in:

• Hypersensitivity.

Use Cautiously in:

• Severe renal impairment
• Severe hepatic impairment
• OB: Safety not established in pregnancy
• Lactation: Safety not established in breastfeeding
• Geri: ↑risk of toxicity in older adults.

Derm: rash, urticaria.

EENT: blurred vision, optic neuritis.

GI: bitter taste, diarrhea, enterocolitis, glossitis, nausea, stomatitis, vomiting.

Hemat: bone marrow depression, APLASTIC ANEMIA, neutropenia, thrombocytopenia.

Neuro: confusion, delirium, depression, headache, peripheral neuritis.
Misc: ANGIOEDEMA, fever, (IN NEWBORNS)GRAY SYNDROME.

Drug-Drug:

• May ↑ effects of oral hypoglycemic agents, warfarin, and phenytoin.
• Phenobarbital or rifampin may ↓ levels and effectiveness.
• May delay response to vitamin B or folic acid therapy.
• Bone marrow depression may be additive with bone marrow–depressing agents (antineoplastics).

(Generic available)

• Powder for injection: 1 g/vial;

• IV (Adults): 12.5 mg/kg every 6 hr (up to 100 mg/kg/day).
• IV (Children): Most infections: 12.5 mg/kg every 6 hr (maximum daily dose = 4 g). Bacteremia/meningitis: 18.75 to 25 mg every 6 hr.
• IV (Infants > 2 wk): Most infections: 12.5 mg/kg every 6 hr (maximum daily dose = 4 g).Bacteremia/meningitis: 18.75 to 25 mg every 6 hr.
• IV (Neonates >7 days and >2 kg): 25 mg/kg every 12 hr.
• IV (Neonates birth–7 days or 2 kg): 25 mg/kg once daily.

• Inhibits protein synthesis in susceptible bacteria at the level of the 50S ribosome.

• Bacteriostatic action.

Spectrum:

• Wide variety of gram-positive aerobic organisms including:
  • Streptococcus pneumoniae and other streptococci,
  • Some enterococci (especially vancomycin-resistant).
• Gram-negative pathogens:
  • Haemophilus influenzae,
  • Neisseria meningitidis,
  • Salmonella,
  • Shigella.
• Anaerobes:
  • Bacteroides fragilis,
  • Prevotella melaninogenica.
• Other organisms inhibited:
  • Rickettsia,
  • Chlamydia,
  • Mycoplasma.

Therapeutic Classification: anti-infectives

Absorption: IV administration results in complete bioavailabililty.

Distribution: Widely distributed to tissues. Crosses the blood-brain barrier with CSF levels 60% of serum values.

Metabolism/Excretion: Mostly metabolized by the liver; <10% excreted unchanged by the kidneys.

Half-life: 1.5–3.5 hr.

Chloromycetin

(plasma concentrations)

• Advise patient to contact health care professional immediately if signs of unusual bleeding; bruising; fever; sore throat; nausea; vomiting; diarrhea; or numbness, tingling, or burning pain or weakness in hands or feet occurs. Medication should be discontinued with the onset of these symptoms.
• Reassure patient that bitter taste 15–20 sec following injection is limited to 2–3 min.
• Instruct patient to report signs of superinfection (stomatitis, perianal itching, vaginal discharge, fever).
• Emphasize the importance of follow-up exams. Bone marrow depression may develop wk to mo after drug therapy has been discontinued.
• Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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