Chloramphenicol (Chlormycetin) Dosing in Chronic Kidney Disease
No dose adjustment is required for chloramphenicol in patients with chronic kidney disease, including those on hemodialysis or peritoneal dialysis, as the drug is primarily metabolized hepatically rather than renally cleared. 1
Pharmacokinetic Rationale
- Chloramphenicol undergoes predominantly hepatic metabolism via CYP3A4, with minimal renal elimination of the parent compound 1
- The elimination half-life is only slightly increased in patients with markedly reduced renal or hepatic function 1
- Hemodialysis and peritoneal dialysis are not effective in removing chloramphenicol from the serum 1
- Dosage schedules do not need to be modified in patients with renal or hepatic disease 1
Standard Dosing Applies Across All CKD Stages
- Maintain standard chloramphenicol dosing regardless of creatinine clearance level, including CrCl <30 mL/min 1
- No supplemental dosing is required post-hemodialysis 1
- No interval adjustment is necessary for any stage of renal impairment 1
Critical Monitoring Considerations
- While dose adjustment is unnecessary, therapeutic drug monitoring may still be warranted in patients with severe renal impairment who are taking multiple interacting medications 2
- The drug's therapeutic index and potential for bone marrow toxicity warrant clinical vigilance regardless of renal function 3
Common Pitfall to Avoid
- Do not reduce chloramphenicol doses or extend dosing intervals based solely on reduced creatinine clearance, as this approach is appropriate only for renally cleared antibiotics (such as aminoglycosides, fluoroquinolones, or beta-lactams) but not for hepatically metabolized drugs like chloramphenicol 1, 3