Report on the Comparative Effectiveness and Safety of Chloramphenicol Injection

The available randomized controlled trial evidence suggests that third generation cephalosporins are as effective as standard treatment regimens that include chloramphenicol for the treatment of bacterial meningitis. Once or twice daily dosing schedules with ceftriaxone are more convenient than the four times daily schedules required for chloramphenicol and ampicillin regimens. There is also some evidence to suggest that shorter courses of treatment may be possible with ceftriaxone. Many of the trials were conducted in the 1980s and 1990s. It difficult to apply the results of these studies to current routine practice, where the effectiveness of chloramphenicol may be markedly reduced with increasing evidence on the emergence of chloramphenicol resistant strains of Haemophilus influenzae. Over time, the prices of third generation of cephalosporins have also come down, so the price differentials are smaller. In some settings, treatment with ceftriaxone may be cheaper than for chloramphenicol. Concerns about the adverse effects of chloramphenicol have not been borne out in the clinical trials. There were no reports of the severe haematological side effects that have led to limited use of chloramphenicol in developed country settings. In the trials available, ceftriaxone was often associated with more adverse effects than conventional therapy, particularly more diarrhoea. The haematological side effects of chloramphenicol remain a concern, but the balance of benefits versus harms favours use of chloramphenicol in severe life threatening infections.