Chloramphenicol Clearance in Infants

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Abstract
Chloramphenicol clearance was evaluated over one dosing interval in 10 infants after at least 24 hours of therapy to evaluate dosage guidelines using a specific chemical assay. Serum samples were obtained prior to and at 1, 2, 4, and 6 hours after the start of a 20-minute infusion of 25 mg/kg chloramphenicol as the sodium succinate. The chemical assay used is technically simple and is specific for unesterified chloramphenicol. Peak serum concentrations ranged from 20.9 to 94.0 μg/ml and occurred from 1 to 4 hours after infusion. Clearances ranged from 0.058 to 0.236 1./kg · hr and paralleled previously reported results using different assay methodology. The 4-hour serum chloramphenicol concentrations were significantly lower (P < 0.05) in infants on phenobarbital. The currently recommended dose of chloramphenicol for severe infections, 100 mg/kg per day, is excessive in some infants. Widely divergent clearance rates prohibit uniform dosage guidelines so that serum level monitoring with an assay specific for chloramphenicol is essential.