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Introduction and Objectives: The use of chloramphenicol in developing countries is widely supported by the World Health Organization to treat bacterial infections, especially those caused by gram-negative bacteria. Wealthier regions favor other antibiotics, since there are concerns regarding chloramphenicol’s adverse effects, such as aplastic anemia. Nevertheless, the rise of multidrug resistant-bacteria has brought a growing interest on chloramphenicol as a new strategy to fight antimicrobial resistance, since the recent reports of its toxicity are very uncommon. This retrospective study intends to characterize the use of chloramphenicol in a tertiary care hospital in Brazil and report any adverse reactions.
Methods: Retrospective analysis of clinical records of pediatric patients admitted to the Pediatric Department of Instituto de Medicina Integral Professor Fernando Figueira, between May 2017 and April 2018, and treated with chloramphenicol.
Results: One hundred and twenty-four patients were included, with a median age of 4.5 years (one month-14 years) and male predominance (54%). Chloramphenicol was mostly used to treat respiratory infections (85%), skin and soft tissue infections (6%), or diseases of ear, nose and throat (6%). It was the first-choice antibiotic in 42% of the patients, who presented a shorter length of stay (7.4 versus 11.1 days, p=0,02). Parenteral treatment was the choice for 91% of patients, for an average of 5.3 days. No adverse reactions were reported, either hematologic or another, and no late side effects were reported on the 13 patients evaluated after one year after hospital discharge.
Conclusion: No early or late side effects to the use of chloramphenicol were reported in this study. The alarming spread of antimicrobial resistance, especially in nosocomial agents, prompts the rational use of older antibiotics, such as chloramphenicol, particularly in severe infections. Chloramphenicol appears to be an effective antibiotic when used in specific situations. With the widely known potentially severe adverse side effects rarely being described in centers which have the adequate experience for routine usage, and the ongoing increase in antimicrobial resistance to currently available antibiotics, the interest in using chloramphenicol may grow in the future.
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