Intravenous chloramphenicol in seriously ill infants and children

One hundred and seven seriously illpediatric patients were treated with intravenous chloramphenicol. The clinical responses were evaluated in 91. Sixteen others were included for study of tolerance, side effects, and toxicity. These 16 had illnesses that could not be expected to be influenced by the drug. In the majority treatment was continued with oral chloramphenicol as soon as the patient's condition permitted. A few also received the drug intramuscularly. Of the 91 patients, 76 improved and 15 did not respond to chloramphenicol. Of the latter, 7 died. These were discussed in some detail. The average duration of fever afterthe start of intravenous chloramphenicol in the improved patients was 3 days. The average dosage of intravenous chloramphenicol was 68 mg. per kilogram of body weight per day given in divided doses. To the majority it was given every 6 hours. The average total duration of intravenous administration was 3 days. The currently recommended intravenous dose is 15 to 20 mg. per kilogram of body weight every 6 hours (or 60 to 80 mg. per kilogram of body weight per day). Except for one patient, the side reactions and toxic reactions were mild and transient. The most common was thrombophlebitis. To minimize this, special care must be exercised in preparation of the “Chloramphenicol Solution” for intravenous use. This procedure is described with emphasis upon the important details. Diarrhea, skin rash, and transient granulocytopenia also occurred in a few cases. One child already critically ill and malnourished developed thrombocytopenia and anemia. This patient also received other drugs, some of which we have been reported to cause similar reactions. At autopsy, abscesses due to Micrococcus pyogenes var. aureus were found in all the internal organs. The role of the infection itself in causing bone marrow depression in such a case is difficult to evaluate. It apears that intravenous chloramphenicol is therapeutically effective in infections in which there are indications for this drug. It is relatively very well tolerated and is an important addition to the therapeutic regimen in seriously ill patients until such time that the drug can be taken orally.