Patient leaflet - Chloramphenicol 1 g powder for solution for injection
1. What Chloramphenicol Injection is and what it is used for
This medicine contains chloramphenicol sodium succinate, which is an antibiotic used to treat severe infections such as typhoid and meningitis, and should only be used when other antibiotics do not help or are unsuitable. It is also used when oral chloramphenicol cannot be used or when higher amounts of the medicine is needed in the blood.
Chloramphenicol prevents bacteria making an essential nutrient required for growth and
multiplication. In time, the number of bacteria are reduced and the infection is controlled, so that treatment can be continued using a more gentle antibiotic.
You must talk to a doctor if you do not feel better or if you feel worse.
2. What you need to know before you are given Chloramphenicol Injection
Do not use Chloramphenicol Injection
- If you have had an allergic reaction (e.g. rash, wheezing) to chloramphenicol before.
If you are pregnant, or are breast-feeding.
Warnings and precautions
Talk to your doctor or pharmacist:
- If you have a history of kidney or liver disease.
- If you are already taking any other medicines which may also cause bone marrow depression.
- If you have a cold, viral influenza, throat infection and before using this medicine to prevent bacterial infections.
- If you have recently been or are about to be vaccinated.
This medicine is associated with various forms of anaemia (a decrease in red blood cells, white blood cells and platelets), which in turn leads to a loss of immunity and can progress into leukaemia. It should only be prescribed if less toxic antibiotics are not available.
New-born babies should be treated with care to avoid Grey Syndrome, which is a serious condition arising from excessive toxic chloramphenicol metabolites. Treatment should be terminated as soon as symptoms are identified.
There is a risk of over-growth of non-susceptible organisms, which can lead to severe diarrhoea up to a few months after this medicine is given to the patient.
Other medicines and Chloramphenicol 1g Powder for Solution for Injection:
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.
The following medicines interact with Chloramphenicol Injection, which affects the way that one or the other medicine works:
- anticoagulants of the coumarin-type (to thin your blood or stop it clotting), antidiabetic agents (e.g. tolbutamide), anti-epileptic agents (e.g. phenytoin and phenobarbital) or rifampicin (an antibiotic).
Pregnancy and breast-feeding
Do not use chloramphenicol if you are pregnant, or are breast-feeding.
Driving and using machines
No effect on the ability to drive or use machinery is expected with Chloramphenicol Injection.
Chloramphenicol Injection contains sodium
This medicine contains 71.2 mg sodium (main component of cooking/ table salt) in each vial. This is equivalent to 3.6% of the recommended maximum daily dietary intake of sodium for an adult.
PACKAGE LEAFLET: INFORMATION FOR THE PATIENT
Chloramphenicol 1g Powder for Solution for Injection
The following information is intended for medical or healthcare professionals only:
Chloramphenicol 1 g Powder for Solution for Injection Chloramphenicol sodium succinate equivalent to 1 g chloramphenicol.
Powder for solution for injection
After parenteral administration chloramphenicol is rapidly released from chloramphenicol sodium succinate. Chloramphenicol Injection is a broad spectrum antibiotic and is active against many gram-positive and gram-negative organisms, Spirillae and Rickettsia. It acts by interfering with bacterial protein synthesis.
Chloramphenicol is widely distributed in body tissues and fluids and enters the cerebrospinal fluid. Chloramphenicol sodium succinate, free chloramphenicol and metabolites are excreted in the urine.
After intravenous administration of chloramphenicol succinate every 6 hours, the elimination half-lives were 4.03 hours for chloramphenicol and 2.65 hours for chloramphenicol succinate. After intravenous administration steady state peak concentrations were reached on average 18.0 minutes after cessation of the infusion. In infants and children aged 3 days to 16 years the apparent half-life was extremely variable ranging from 1.7 to 12.0 hours.
Indications
Chloramphenicol Injection is indicated for typhoid, meningitis caused by H. influenzae and other serious infections caused by bacteria susceptible to chloramphenicol.
Chloramphenicol should be used only when it is considered inappropriate to use antibacterial agents that are commonly recommended for the initial treatment of the infections listed above, or when these alternative antibacterial agents have failed to demonstrate efficacy. Consideration should be given to official guidance on the appropriate use of antibacterial agents.
It is also indicated wherever chloramphenicol is deemed the antibiotic of choice and oral administration is not possible, or where higher than usual blood concentrations are required.
Posology and method of administration
Posology
The dose administered and the concentration used is dependent on the severity of the infection.
The recommended standard dosage is as follows: Adults: The equivalent of 1 g of chloramphenicol every 6-8 hours.
Elderly: The usual adult dosage should be given subject to normal hepatic and renal function.
Children: The equivalent of 50 mg/kg chloramphenicol, according to body weight, daily in divided
doses every 6 hours (this dose should not be exceeded). The patient should be carefully observed for signs of toxicity.
Premature Infants and Neonates: A total of 25 mg/kg/ day in 4 equal doses at 6-hour intervals
usually produces and maintains concentrations in blood and tissues adequate to control most infections for which the drug is indicated.
Only 10% or lower concentrations to be used. The injection should be reconstituted in water for injections, sodium chloride injection or dextrose injection 5%. The product for intramuscular injection should be reconstituted only in water for injections; the osmolarity of sodium chloride injection or dextrose injection 5% may cause pain at the site of injection.
Dosage in special clinical conditions
In exceptional cases, such as patients with septicaemia or meningitis, dosage schedule up to 100 mg/kg/ day may be prescribed. However, these high doses
should be decreased as soon as clinically indicated. To prevent relapses, treatment should be continued after the temperature has returned to normal for 4 days in rickettsial diseases and for 8-10 days in typhoid fever. Method of administration
To be given by intravenous injection or infusion or by intramuscular injection.
In order to ensure rapid attainment of high blood levels, Chloramphenicol Injection is best administered intravenously. Where this is not possible, intramuscular administration may be used, although absorption may be slow and unpredictable. The use of the intramuscular route should be restricted to those patients where parenteral administration is considered most appropriate but intravenous use is impossible or impractical. Intravenous administration should be as a 10% (100 mg/mL) solution to be injected over at least a one-minute interval, or in a larger volume of fluid, by slow intravenous infusion after reconstitution. The same 10% (100 mg/mL) solution can also be administered intra-muscularly, if necessary. Since the recommended dose for neonates and premature infants is 25 mg/kg daily, divided in multiple doses, it might be difficult to achieve such a dose with 100 mg/ml (10%) concentration in case of a small infant. In such cases, a solution of lower concentration may be used.
Chloramphenicol Injection should be administered intravenously as a 10% (100 mg/ml) solution or lower, that can be prepared by diluting the lyophilized powder in the vial with 9.2 ml of diluent (see table below). The resulting solution can be administered as an intravenous bolus, intravenous infusion or intramuscular injection. The use of the intramuscular route should be, however, restricted only to those patients where intravenous access is unavailable. The solution can be reconstituted with the following diluents:
- Water for injections
- 0.9% sodium chloride
- 5% dextrose
1 vial containing
1.377 g of
chloramphenicol
sodium
succinate
(equivalent to
1 g of
laevorotatory
chloramphenicol
Route of
administration Amount of diluent to be added (ml)
Resulting concentration in mg/ml (%)
Intravenous
bolus
(1 minute)
Slow
intravenous
Infusion
Intramuscular
injection
9.2 ml 100 mg/ml
(10%)
*Includes 0.8 ml water from gaseous phase in vial Any unused medicinal product or waste material should be disposed of in accordance with local requirements. Contraindications
Chloramphenicol is contraindicated in patients with a previous history of sensitivity and/or toxic reactions to chloramphenicol.
Special warnings and precautions for use
Chloramphenicol is to be administered only under the direction of a medical practitioner. It should be reserved for serious infections caused by organisms susceptible to its antimicrobial effects when less toxic antibiotics are ineffective or contraindicated. However, chloramphenicol may be chosen to initiate antibiotic therapy based on the clinical impression. In vitro sensitivity tests should be performed concurrently so that the drug may be Healthcare Professional Information Leaflet
3. How Chloramphenicol Injection is given to you
Chloramphenicol Injection will be made into a solution and be given to you by injection into a vein, or into a muscle under the direction of a medical practitioner. Your doctor will prescribe the required amount (the dose). The dose is decided by taking into account the severity of your condition.
Adults:
The recommended dosage for adults is; 1g of chloramphenicol every 6-8 hours.
Use in children and adolescents:
The recommended dose for children is; 50 mg/kg of chloramphenicol daily in divided doses every 6 hours (no more than this should be given); and
25 mg/kg daily in divided equal doses every 6 hours in new-born and premature infants.
The doctor may give you more in certain cases e.g. if you have septicaemia or meningitis (100mg/kg/day), but should then be decreased as soon as appropriate. Your doctor will decide how long you need to be treated for. During treatment your doctor will carry out blood tests to check that:
- Your blood is functioning properly as Chloramphenicol Injection can damage your blood cells.
- Your liver and kidneys are functioning properly as Chloramphenicol Injection may affect these organs.
If you are given more Chloramphenicol Injection than you should
In the case of serious overdosage, charcoal
haemoperfusion may be effective in removing chloramphenicol from your blood.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them. Tell your doctor immediately if any of the following side effects occur:
- Severe allergic reaction e.g. red raised areas on your skin which may look like spots or be several inches across, which cause itchiness.
- Grey Syndrome – usually in new-born or premature infants, where the skin appears grey, and the infant is listless and weak.
- White blood cell counts (which fight infection) can also drop, increasing the chance of infections, bruising and fever.
Anaemia (a low red blood cell count) that can leave you feeling tired and lethargic.
Other side effects may occur, but, the frequency cannot be estimated from the available data:
- Dry mouth.
- Nausea (feeling sick), vomiting (being sick) and diarrhoea.
- Headache.
- Depression.
- Inflammation or damage to the nerves causing numbness, tingling, pain or muscle weakness.
- Blurring, inflammation or temporary loss of vision.
- Chloramphenicol may slow down development of immunity, and you may develop infections more frequently, which are difficult to fight off.
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Chloramphenicol Injection
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the vial label and on the carton after EXP. The expiry date refers to the last day of that month. Keep the vial in the outer carton in order to protect from light.
Store below 25°C.
6. Contents of the pack and other information
What Chloramphenicol Injection contains
The active substance is chloramphenicol sodium succinate. There are no other ingredients found in Chloramphenicol 1g Powder for Solution for Injection. (See end of Section 2 for further information on sodium).
What Chloramphenicol Injection looks like and contents of the pack
Chloramphenicol 1g Powder for Solution for Injection is available as single glass vials. Each vial contains a freeze-dried powder containing the equivalent of 1g chloramphenicol.
Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder :
Kensington Pharma Ltd,
Unit A Newlands House,
60 Chain House Lane,
Whitestake Preston, Lancashire,
PR4 4LG, United Kingdom
Manufacturer:
FISIOPHARMA s.r.l.
Nucleo Industriale
84020 Palomonte (SA)
Italy
This leaflet was last revised in 05/2024.
discontinued as soon as possible if a less toxic antibiotic is indicated by the results of such tests. The decision to continue use of chloramphenicol, rather than another antibiotic when both are suggested by in vitro studies to be effective against a specific pathogen, should be based upon severity of the infection, susceptibility of the pathogen to the various antimicrobial drugs, and the efficacy of the various drugs in the infection. Chloramphenicol should not be used for trivial infections due to the possibility of severe blood dyscrasias, which may prove fatal.
Bone marrow depression and blood disorders Serious and fatal blood dyscrasias (aplastic anaemia, hypoplastic anaemia, thrombocytopenia, granulocytopenia, and bone marrow depression) are known to occur after the administration of chloramphenicol. In addition, there have been reports of aplastic anaemia attributed to chloramphenicol, which later resulted in leukaemia. Blood dyscrasias have occurred after both short-term and prolonged therapy with this drug. Chloramphenicol must not be used in the treatment of any infection for which a less toxic antibiotic is available.
Patient monitoring
Because of its toxic nature it is important to monitor serum levels of this antibiotic particularly in new-born and premature infants, in the elderly, in patients with renal or hepatic disease and in those receiving other drugs with which chloramphenicol may interact.
It is essential that adequate haematologic functions be closely monitored during treatment with chloramphenicol. While haematologic determinations may detect early peripheral haematologic changes, such as leucopoenia, reticulocytopenia, or granulocytopenia, before they become irreversible, such determinations cannot be relied on to detect bone marrow depression prior to the development of aplastic anaemia. It is desirable that patients be hospitalised during therapy, so that appropriate laboratory determinations and clinical observations can be made.
Baseline haematologic determinations should be made and determinations repeated approximately every two days during therapy. The drug should be discontinued upon appearance of reticulocytopenia, leucopoenia, thrombocytopenia, anaemia, or any other haematologic findings attributable to chloramphenicol. However, such determinations do not exclude the possible later appearance of the irreversible type of bone marrow depression.
Repeated courses of the drug should be avoided if at all possible. Treatment should not be continued longer than required to produce a cure with little or no risk of relapse of the disease. Concurrent therapy with other drugs that may cause bone marrow depression should be avoided. Hepatic or Renal Impairment
Excessive chloramphenicol serum levels may result from administration of the recommended dose to patients with impaired liver or kidney function, including that due to immature metabolic processes in the infant. Dosage should be adjusted accordingly or, preferably, the serum concentration should be determined at appropriate intervals.
Grey syndrome in infants and neonates
Precaution should be used in therapy of premature and full-term neonates to avoid “Grey Syndrome” toxicity. Serum drug levels should be carefully monitored during therapy of the neonate (newborn infant).
Toxic reactions, including fatalities, have occurred in premature infants and neonates. The signs and symptoms associated with these reactions have been referred to as the “Grey Syndrome”. Although “Grey Syndrome” has been reported in neonates born to mothers after having received chloramphenicol during labour, in most cases
therapy with chloramphenicol has been instituted within the first 48 hours of life. The following summarises the clinical and laboratory determinations that have been made on these patients.
Symptoms first appeared after 3 to 4 days of continued treatment with high doses of chloramphenicol. The symptoms appeared in the following order: abdominal distension with or without emesis, progressive pallid cyanosis, vasomotor collapse, frequently accompanied by irregular respiration, death within a few hours of onset of these symptoms.
The progression of symptoms from onset to death was accelerated with higher dose schedules. Serum drug levels revealed unusually high concentrations of chloramphenicol (over 90 mcg/mL after repeated doses). Termination of therapy upon early evidence of the associated symptomatology frequently reversed the process with complete recovery following. General
Chloramphenicol must not be used in the treatment of trivial infections or where it is not indicated, as in colds, viral influenza, infections of the throat or as a prophylactic agent to prevent bacterial infections. Superinfections
The use of chloramphenicol, as with other antibiotics, may result in an overgrowth of non-susceptible organisms, including fungi. If infections caused by non-susceptible organisms appear during therapy, appropriate measures should be taken.
Clostridium difficile associated diarrhoea (CDAD) has been reported with use of nearly all antibacterial agents, including chloramphenicol, and may range in severity from mild diarrhoea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD.
Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhoea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
Effects on immunity
Chloramphenicol may also impede the development of immunity and should therefore not be given during active immunisation.
Interaction with other medicinal products and other forms of interaction
Chloramphenicol has been shown to interact with, and enhance the effects of coumarin anticoagulants, some hypoglycaemic agents (e.g. tolbutamide) and phenytoin. When given concurrently, a dose reduction of these agents may be necessary.
Plasma concentrations of chloramphenicol may be reduced with concomitant usage of phenobarbital and rifampicin.
Fertility, pregnancy and lactation
The use of chloramphenicol is contraindicated in pregnancy and whilst breastfeeding.
Special precautions for storage
Keep the vial in the outer carton in order to protect from light. Store below 25°C.
Pack size
1, 20 or 25 vials.