What are the adverse effects associated with Chloramphenicol (antibiotic)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: May 25, 2025 • View editorial policy

From the Guidelines

Chloramphenicol is associated with serious adverse effects, including bone marrow suppression, aplastic anemia, and Gray baby syndrome, making it a less desirable option due to its potential to increase mortality compared to other antibiotics 1.

Adverse Effects of Chloramphenicol

The use of chloramphenicol can lead to several adverse effects, primarily due to its impact on the bone marrow and its potential to cause aplastic anemia, a condition that is dose-independent and potentially fatal. Other common side effects include:

  • Gastrointestinal disturbances such as nausea, vomiting, and diarrhea
  • Neurological effects like optic neuritis, peripheral neuropathy, and headaches
  • Hypersensitivity reactions including fever, rash, and angioedema
  • Long-term use may result in superinfections, particularly with resistant organisms or fungi ### Considerations for Use Given the serious risks associated with chloramphenicol, its use is now generally reserved for severe infections where safer alternatives are ineffective or unavailable 2. It is crucial to monitor blood counts regularly during treatment and discontinue the drug immediately if significant bone marrow suppression occurs.

Recommendations

The use of chloramphenicol should be approached with caution, considering its potential for serious adverse effects and the availability of safer alternatives 1. Key points to consider:

  • Chloramphenicol can cause serious adverse effects, including bone marrow suppression and aplastic anemia
  • The drug is associated with higher mortality compared to other antibiotics
  • Safer alternatives should be considered before prescribing chloramphenicol
  • Regular monitoring of blood counts is essential during treatment with chloramphenicol

From the FDA Drug Label

ADVERSE REACTIONS: Blood Dyscrasias The most serious adverse effect of chloramphenicol is bone marrow depression. Serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, and granulocytopenia) are known to occur after the administration of chloramphenicol Gastrointestinal Reactions Nausea, vomiting, glossitis and stomatitis, diarrhea and enterocolitis may occur in low incidence. Neurotoxic Reactions Headache, mild depression, mental confusion, and delirium have been described in patients receiving chloramphenicol Hypersensitivity Reactions Fever, macular and vesicular rashes, angioedema, urticaria, and anaphylaxis may occur. "Gray Syndrome" Toxic reactions including fatalities have occurred in the premature and neonate; the signs and symptoms associated with these reactions have been referred to as the “gray syndrome.

The adverse effects associated with cloranfenicol (chloramphenicol) include:

  • Blood dyscrasias: bone marrow depression, aplastic anemia, hypoplastic anemia, thrombocytopenia, and granulocytopenia
  • Gastrointestinal reactions: nausea, vomiting, glossitis, stomatitis, diarrhea, and enterocolitis
  • Neurotoxic reactions: headache, mild depression, mental confusion, and delirium
  • Hypersensitivity reactions: fever, macular and vesicular rashes, angioedema, urticaria, and anaphylaxis
  • Gray syndrome: toxic reactions including fatalities in premature and neonate patients 3

From the Research

Adverse Effects of Chloramphenicol

The adverse effects associated with chloramphenicol include:

  • Bone marrow suppression, which is reversible and dose-related 4, 5, 6
  • Aplastic anemia, which is rare but can be fatal 4, 5, 7, 8
  • Gray baby syndrome, which occurs in premature and newborn infants receiving high or unmodified doses of chloramphenicol 4, 5, 6
  • Myelotoxicity, which can be minimized by using chloramphenicol at the recommended doses and monitoring levels 7, 8

Incidence of Adverse Effects

The incidence of adverse effects varies, with:

  • Aplastic anemia occurring in approximately 1 in 24,500-40,800 courses of treatment 5
  • Reversible bone marrow suppression being the most common toxicity 5
  • Gray baby syndrome being avoidable by reduction of dosage and monitoring of serum levels in newborn infants 4, 5

Management of Adverse Effects

To minimize the risk of adverse effects, it is recommended to:

  • Monitor serum levels of chloramphenicol, especially in patients with liver disease and neonates 4, 5, 6
  • Use chloramphenicol at the recommended doses and adjust according to age and individual patient needs 4, 5, 6
  • Be aware of the potential for myelotoxicity and monitor for signs of bone marrow suppression 7, 8

References

4
Research

Chloramphenicol: properties and clinical use.

Pediatric infectious disease, 1982

5
Research

Chloramphenicol: A review of its use in clinical practice.

Reviews of infectious diseases, 1981

6
Research

Chloramphenicol: new perspectives on an old drug.

Drug intelligence & clinical pharmacy, 1982

8
Research

[Role of chloramphenicol in current clinical practice].

Klinicka mikrobiologie a infekcni lekarstvi, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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