The public health impact of making chloramphenicol an over-the-counter antibiotic: a systematic literature review

Abstract

<p><strong>Purpose: </strong>Chloramphenicol is an over-the-counter ocular antibiotic in some countries (for example Australia since 2010 and the United Kingdom since 2005), but concerns regarding resistance and adverse effects have prevented other countries from doing the same. Therefore, this systematic review was conducted to answer the question of whether chloramphenicol is a safe and effective topical antibiotic for treating ocular infections, and whether it should be reclassified as an over-the-counter medication.</p><p><strong>Methods: </strong>A search of the Medline and Embase databases was conducted to identify articles concerning the effectiveness of chloramphenicol in treating ocular infections, bacterial susceptibility towards chloramphenicol, the risk of adverse effects, and the results of reclassifying chloramphenicol as an over-the-counter antibiotic in the past. A total of 131 articles were evaluated for this systematic review.</p><p><strong>Results: </strong>The literature did not support any concerns regarding side effects such as aplastic anaemia. Chloramphenicol was comparable in efficacy to other antibiotics in treating ocular infections, and resistance has remained low over the past decade, save for bacterial species with known intrinsic resistance such as Pseudomonas aeruginosa. Chloramphenicol use increased in the first few years following reclassification as an over-the-counter medication, but eventually plateaued.</p><p><strong>Conclusion: </strong>Chloramphenicol is a safe and effective topical antibiotic for treating ocular infections, and there is minimal concern of adverse effects such as aplastic anaemia resulting from topical use. Nonetheless, multiple clinical and socioeconomic factors should be factored in when considering reclassification, and contextual factors such as population density, eye care accessibility and health-seeking behaviours may influence the decision.</p>