Clinical beta
FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.
Drug Monograph
Chloramphenicol
Amphenicol (IV, PO)
Indication
Meningitis alt resource-limited β’ rickettsia β’ eye topical
INDICATIONS (CORE USE)
**Niche** meningitis/rickettsia/some anaerobes where modern drugs unavailable β **gray baby syndrome** neonates; **aplastic anemia** idiosyncratic rare; **monitor levels**.
ADULT DOSE (STANDARD)
50β100 mg/kg/day IV divided q6h β max 4 g/day; **levels**
MAX DOSE
4 g/day adult; serum concentration targets 10β20 mcg/mL typical peak monitoring era-dependent
Route
IV, PO, topical ocular
PEDIATRIC DOSE
Same mg/kg β neonates avoid/titrate β gray baby
Must-not-miss safety points
Major warning
- **Irreversible aplastic anemia** idiosyncratic (rare, catastrophic) - **Gray baby syndrome** in neonates β circulatory collapse - **Bone marrow suppression** reversible dose-related - Inhibits mitochondrial protein synthesis β human toxicity
USE IF: MDR meningitis / epidemic typhus / specific infections only when first-line unavailable + therapeutic drug monitoring. AVOID IF: Neonates without NICU monitoring; first-line alternatives exist.
Primary
Secondary
Other
STANDARD (ADULT PO)
50 mg/kg/day IV divided q6h (max ~4 g/day adult) β TDM if available
ADULT DOSE
50 mg/kg/day divided q6h; reduce hepatic impairment
PEDIATRIC DOSE
Neonates β avoid or extreme caution with levels.
MAX DOSE
4 g/day
Practical Note
TDM if available; watch CBC reticulocytes.
Clinical warnings
Adverse effects
Pediatrics
Same mg/kg β neonates avoid/titrate β gray baby
Pregnancy
Placental β gray baby risk term
Lactation
avoid if alternatives.
Renal impairment
Adjust hepatic metabolism dominant β severe renal + hepatic caution. **CrCl scaffold (FMBM β titrate to FDA/SFDA label + institutional pharmacy nomogram):** - **CrCl β₯50** β standard systemic dosing per program - **CrCl 10β50** β reduce dose/interval; **TDM** if available - **CrCl <10** / **HD** β monitor levels + toxicity; gray baby risk **neonates**
Hepatic impairment
Reduce dose β accumulation.
Elderly
Marrow suppression risk.
IV infusion; oral caps.
Clinical Picture
**Life-threatening (first):** **aplastic anemia** risk (idiosyncratic); **cardiovascular collapse** (massive). **Secondary:** reversible marrow suppression; gray baby (neonates).
Immediate Actions
Stop β CBC; transfuse/support as indicated
Antidote
No specific antidote; treat complications (e.g. anaphylaxis β epinephrine per ACLS)
Decontamination
Charcoal if early PO
Escalation
Severe pancytopenia with sepsis, cardiovascular collapse β **ICU** / hematology; **severe renal failure β consider HD** for clearance discussion β pharmacy
Common mistakes, resistance logic, and bedside traps
**1940s broad-spectrum ghost** still used in pockets. **Aplastic anemia** lotto ticket. **Neonatal gray death** without monitoring.
Stewardship: reserve for true niche. TDM if used IV. Topical eye β systemic safety profile but still avoid casual use. *Stewardship (all antimicrobials):* Empiric choice β syndrome severity + **local antibiogram**; shortest effective course.
Hepatic glucuronidation; penetrates CSF well.
50S ribosome inhibitor β blocks peptidyl transferase.
Global data (no country-specific data available)
Saudi Arabia
(placeholder β verify local formulary)
Common trade names are curated examples only β formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.
Saudi Arabia
International