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Death of three newborn infants (without obvious immediate cause of death at necropsy) followed administration of moderately large amounts of chloramphenicol.The recommended intramuscular dose of the microcrystalline suspension of chloramphenicol in aqueous vehicle was 100 to 150 mg. per kilogram of body weight per day for children of 15 kg. or less.1-3 One death occurred after administration of 220 mg. per kilogram per day for 60 hours.Another death occurred after administration of 230 mg. per kilogram per day for 72 hours. The recommended oral dose of the suspension of chloramphenicol palmitate for children of 15 kg. or less was 50 to 100 mg. per kilogram per day4 up to 100 to 150 mg. per kg. per day.3,5 One death occurred after 50 mg. per kilogram per day for 56 hours and 10 hours after a single inadvertent oral dose of 400 mg.The use of doses of chloramphenicol of the size recorded here has not been reported previously in newborn infants, and there has been little opportunity to observe pos¬ sible adverse effects of such large amounts.Because of the wide antibacterial spectrum of chloramphenicol, the drug has been ex¬ tremely useful. It is considered to be well tolerated and nontoxic, at least over short periods of time. Report of these possible adverse results of chloramphenicol therapy may permit other more definitive and bet¬ ter-controlled observations and indirectly result in a more rational application of a useful chemotherapeutic agent to the new¬ born infant with bacterial infection. Report of CasesCase 1.-The infant was a 3,440 gm. boy, born ' of a 33-year-old white married Gr. V, Group A, Rh+ mother with negative serologie test for syphilis at 40 weeks' gestation. During pregnancy the mother had a blood pressure of 140/80, and complained of edema and visual disturbances. Two previous pregnancies had resulted in spontaneous abortions at 12 and 6 weeks. The first two preg¬ nancies terminated at 40 weeks with delivery of normal infants.By history, membranes ruptured one week before delivery. The infant was delivered spontaneously by cephalic presentation 20 minutes after 100 mg. of meperidine (Demerol) hydrochloride, 1 mg. of levallorphan lartrate (Lorfan), and 1/150 grain (0.4 mg.) of scopolamine, and 4l/2 hours after onset of labor. Agar score was 10.Initial examination of the infant revealed no abnormalities. Menadione sodium bisulfite, 5 mg., was given, and, because of the premature rupture of the maternal membranes, 50,000 units of pro¬ caine penicillin and 50 mg. of streptomycin intra¬ muscularly every 12 hours were ordered. At 8 to 10 hours of age the infant went to breast and fed well. On the second day he was circumcised.At 3 days of age, jaundice was noted and there was periumbilical erythema which extended in a 13/761

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Summary: An outbreak of anticonvulsant intoxication occurred in epileptic patients in Australia during 1968-9. All affected patients studied in Brisbane were taking one brand-of phenytoin. In 87% of them the blood phenytoin levels were above the therapeutic range. Reduction of phenytoin dosage relieved the intoxication in all patients. The excipient in the responsible phenytoin capsules had been changed several months before the outbreak, and this change was probably related causally to the altered blood phenytoin concentrations.