Bulletin of the World Health Organization

Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics

Marzia Lazzerini & David Tickell

Volume 89, Number 8, August 2011, 594-607

Table 5. Pharmacokinetics of chloramphenicol in children with severe acute malnutrition

Reference Dose (per kg), route No. of children Absorption constant (per h)
Tmax (min)
Cmax (μg/ml) or Css (μg/ml) Bioavailability
Clearance (ml/kg/h)
Half life (m) or Ke (per h)
AUC (μg.min/ml)
Malnourished Eutrophic Malnourished Eutrophic Malnourished Eutrophic Malnourished Eutrophic Malnourished Eutrophic Malnourished Eutrophic
Ashton et al. 199341 25 g, IV 34a M: 4.8
K: 2.9*
5.9 M t½: 3.7
K t½: 4.9
t½: 2.4 M: 20.4/kgc
K: 35.9/kgc *
11.1/kgc
Samotra et al. 198642 50 g, oral 12 1.0 1.1 2.1 2.7 Cmax: 18 Cmax: 24 t½: 3.4* t½: 7.0 128* 252
Eriksson et al. 198343 25 g, IV/oral 37 M: 2.3
K: 3.57
MK: 3.96*
1.86 M: 2.3
K: 3.57
MK: 3.96*
1.86 IV Cmax: K > MK > M > Nb
po Cmax: < 5μg/ml
K: 4.16*
M: 8.16
MK: 5.39
7.53 K t½: 3.76*
M t½: 2.88
MK t½: 3.2
t½: 2.85 K > MK > M > N
Bioavail :
M: 57%*
K: 44%*
MK: 30%*
Bioavail: 85%
Mehta et al. 198344 25 g, oral 13 0.045* 1.09 4.0* 2.0 Cmax: 20.5 Cmax: 18.3 t½: 6.86*
Ke: 0.109*
t½: 3.3
Ke: 0.213
32.99/kg* 10.43/kg
Saini et al. 198145 25 mg, IV 21a M: 0.25
K: 0.25
0.25 M Cmax: 10.0*
K Cmax: 11.5*
Cmax: 16.9 M: 380d
K: 370d
340d M t½: 1.227
K t½: 1.245
M Ke: 0.0094
K Ke: 0.0093
t½: 1.32
Ke: 0.009
M: 38.56e
K: 39.50e
38.63e
Mehta et al. 198146 25 g x 8 doses, IV/oral 21a IV CSS pre-dose 18.0*
IV CSS 2h post-dose 24.1*
po CSS pre-dose 16.6*
po CSS 2h post-dose 23.7*
10.0
19.1
9.7
16.0
Mehta et al. 197547 25 mg, oral 14a 4.0 2.0 Cmax: 21.3 Cmax: 17.8 Urine (drug) at 30 h: 40 μg/ml* 100 μg/ml

AUC, area under the plasma concentration time curve; Cmax, maximum concentration; Css, steady-state concentration; IV, intravenous; K, kwashiorkor; Ke, elimination constant; M, marasmus; MK, marasmic kwashiorkor; N, normal (controls); po, per oral; t½, half life; Tmax, time to maximum concentration; U, underweight; * P < 0.05.

a Malnutrition grades were determined using weight for age, not weight for height.

b Although all subtypes of malnutrition had levels 5–25 μg/ml for 4–9 hours.

c Min/mmol used.

d Ml/m2/min used.

e L/g2 used.