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Last Updated: December 12, 2025

CLINICAL TRIALS PROFILE FOR CHLORAMPHENICOL


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All Clinical Trials for chloramphenicol

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00277147 ↗ Salmonella Typhi Vi O-Acetyl Pectin-rEPA Conjugate Vaccine Completed Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Phase 1 2006-01-09 This study will evaluate a new (conjugate) vaccine for typhoid fever, which remains a serious disease especially difficult to treat in developing countries. Salmonella typhi, the bacteria causing typhoid fever, have become resistant to several antibiotics increasing the difficulty of treating the disease. The disease may have serious complications effecting bones, brain, and intestines, with permanent injury or death. Methods to control typhoid fever, such as a sanitary water and food supply, along with effective sewage treatment, are not likely to be available soon in those countries. NIH scientists developed a vaccine called Vi, made of a polysaccharide (a chain of linked sugars) from the surface of Salmonella typhi, the bacteria that cause typhoid fever. It has been approved by the World Health Organization and is licensed in 94 countries. It is effective in adults but not in young children. Clinical trials have shown that chemically binding the Vi to a protein to form a "conjugate vaccine" has improved and extended its efficacy to children (conjugate vaccines to other bacteria, notably meningitis causing bacteria have been used extensively and successfully). Now NIH scientists have developed another vaccine for typhoid fever - using a polysaccharide from fruit, known as pectin. The pectin has been chemically treated so that it resembles Vi. The treated pectin, O-acetyl pectin, is bound to a protein; exoprotein A, (rEPA). The result is a conjugate, as was formed for Vi. Similarly to the Vi conjugate it induces antibodies against Salmonella typhi in laboratory animals. If the O-acetyl pectin conjugate proves successful, it will be evaluated in children ages 5 to 14 years old and in infants, toward using it with routine vaccines for infants. Volunteers ages 18 to 45 who do not have an allergy to fruit pectin and who have not been vaccinated against nor had typhoid fever within the last 5 years may be eligible for this study. Volunteers will undergo several tests at their first visit to the clinic for this study. A blood sample (about 2/3 of an ounce) will be taken to test for HIV, hepatitis B and C, complete blood count, liver functions, blood chemistry and pregnancy in women of childbearing age. The blood sample will also be tested for antibodies to Vi, rEPA (the protein of the conjugate), and pectin. There will also be a urine collection for testing. If the laboratory tests are acceptable, volunteers will be asked to return to the clinic on a...
NCT00372541 ↗ Ceftriaxone Versus Chloramphenicol for Treatment of Severe Pneumonia in Children Completed Makerere University Phase 3 2006-09-01 Acute lower respiratory tract infections are a leading cause of morbidity and mortality in sub Saharan Africa. The World Health Organisation (WHO) still recommends intravenous chloramphenicol for the treatment of severe pneumonia in children aged less than five years. However, up to 20% of children fail treatment due to the emergence of resistance by bacteria. Several centers now use ceftriaxone, a third generation cephalosporin, which is reported to be efficacious in the treatment of severe pneumonia. However the high cost of ceftriaxone is too prohibitive to allow for its routine use in resource constrained countries. The purpose of this study is to compare chloramphenicol and ceftriaxone in the treatment of severe pneumonia in children under five. We hypothesize that 92.7% of children who receive once daily intravenous ceftriaxone (75 mg/kg body weight)for 7 days, will recover from severe pneumonia compared to 80.2 % of those who receive intravenous chloramphenicol (25mg/kg body weight/dose every 6 hours for 7 days).
NCT00579956 ↗ A Randomized Double Blinded Comparison of Ceftazidime and Meropenem in Severe Melioidosis Unknown status Mahidol University N/A 2007-12-01 Melioidosis, an infection caused by the bacterium Burkholderia pseudomallei, is a major cause of community-acquired septicaemia in northeast Thailand. Common manifestations include cavitating pneumonia, hepatic and splenic abscesses, and soft tissue and joint infections. Despite improvements in diagnostic procedures and treatment, the mortality of severe melioidosis remains unacceptably high - approximately 35% with currently used antibiotics (ceftazidime or co-amoxiclav). There is clear evidence that antibiotics can affect mortality; the use of ceftazidime rather than previous regimens (doxycycline + chloramphenicol + co-trimoxazole) led to a 50% reduction in mortality from 80% to 35%. However, the mortality in the first 48 hours has not been altered by any treatment regimen. A key question is whether alternative antibiotics could improve early outcome. The hypothesis tested is that meropenem is superior to ceftazidime in terms of mortality for the treatment of melioidosis.
NCT00579956 ↗ A Randomized Double Blinded Comparison of Ceftazidime and Meropenem in Severe Melioidosis Unknown status Wellcome Trust N/A 2007-12-01 Melioidosis, an infection caused by the bacterium Burkholderia pseudomallei, is a major cause of community-acquired septicaemia in northeast Thailand. Common manifestations include cavitating pneumonia, hepatic and splenic abscesses, and soft tissue and joint infections. Despite improvements in diagnostic procedures and treatment, the mortality of severe melioidosis remains unacceptably high - approximately 35% with currently used antibiotics (ceftazidime or co-amoxiclav). There is clear evidence that antibiotics can affect mortality; the use of ceftazidime rather than previous regimens (doxycycline + chloramphenicol + co-trimoxazole) led to a 50% reduction in mortality from 80% to 35%. However, the mortality in the first 48 hours has not been altered by any treatment regimen. A key question is whether alternative antibiotics could improve early outcome. The hypothesis tested is that meropenem is superior to ceftazidime in terms of mortality for the treatment of melioidosis.
NCT00579956 ↗ A Randomized Double Blinded Comparison of Ceftazidime and Meropenem in Severe Melioidosis Unknown status University of Oxford N/A 2007-12-01 Melioidosis, an infection caused by the bacterium Burkholderia pseudomallei, is a major cause of community-acquired septicaemia in northeast Thailand. Common manifestations include cavitating pneumonia, hepatic and splenic abscesses, and soft tissue and joint infections. Despite improvements in diagnostic procedures and treatment, the mortality of severe melioidosis remains unacceptably high - approximately 35% with currently used antibiotics (ceftazidime or co-amoxiclav). There is clear evidence that antibiotics can affect mortality; the use of ceftazidime rather than previous regimens (doxycycline + chloramphenicol + co-trimoxazole) led to a 50% reduction in mortality from 80% to 35%. However, the mortality in the first 48 hours has not been altered by any treatment regimen. A key question is whether alternative antibiotics could improve early outcome. The hypothesis tested is that meropenem is superior to ceftazidime in terms of mortality for the treatment of melioidosis.
NCT00619203 ↗ Oral Glycerol and High-Dose Rectal Paracetamol to Improve the Prognosis of Childhood Bacterial Meningitis Completed University of Malawi College of Medicine Phase 3 2008-03-01 Bacterial meningitis remains a significant cause of morbidity and mortality in children, especially in countries with limited resources. Efforts to improve the grim outcome have included altering the first line antibiotic therapy, controlling seizures and managing fluids more carefully. Adjuvant therapy of steroids has been used with limited success in children in the West and with no proven value in Malawi and other resource constrained settings. Glycerol has been used to reduce brain oedema in neurosurgery and it has recently been shown to reduce morbidity in childhood meningitis in South America. Paracetamol in a high dosage has been shown to reduce inflammation and cytokine levels in septicaemia with improved outcomes in adults. In Malawi the investigators have tried adjuvant steroids with no improvement in outcome of childhood meningitis. They have recently concluded a study of ceftriaxone which has shown no improvement in mortality though there is less hearing loss than with chloramphenicol and benzyl penicillin. Following the encouraging results of the Childhood South American Study it is important to assess the use of adjuvant glycerol in children in the investigators' setting. Paracetamol is routinely used in meningitis because of the accompanying fever and headache. This is an opportunity to study its place as adjuvant therapy more carefully than has previously been done. The investigators propose a prospective, randomized, double blind 2 by 2 factorial designed study to assess the advantage of ceftriaxone (antibiotic) given with paracetamol and glycerol in combination, singly or with neither adjuvant therapy in childhood bacterial meningitis.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for chloramphenicol

Condition Name

Condition Name for chloramphenicol
Intervention Trials
Cataract Surgery 1
Plague 1
Cholera 1
Pneumonia 1
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Condition MeSH

Condition MeSH for chloramphenicol
Intervention Trials
Pneumonia 2
Necrosis 1
Meningitis 1
Pterygium 1
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Clinical Trial Locations for chloramphenicol

Trials by Country

Trials by Country for chloramphenicol
Location Trials
Thailand 5
Uganda 3
Brazil 3
Iran, Islamic Republic of 3
United Kingdom 1
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Trials by US State

Trials by US State for chloramphenicol
Location Trials
Maryland 1
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Clinical Trial Progress for chloramphenicol

Clinical Trial Phase

Clinical Trial Phase for chloramphenicol
Clinical Trial Phase Trials
Phase 4 3
Phase 3 3
Phase 2/Phase 3 1
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Clinical Trial Status

Clinical Trial Status for chloramphenicol
Clinical Trial Phase Trials
Unknown status 8
Completed 7
Not yet recruiting 1
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Clinical Trial Sponsors for chloramphenicol

Sponsor Name

Sponsor Name for chloramphenicol
Sponsor Trials
Shahid Beheshti University of Medical Sciences 3
University of Oxford 2
University of Malawi College of Medicine 1
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Sponsor Type

Sponsor Type for chloramphenicol
Sponsor Trials
Other 30
U.S. Fed 1
NIH 1
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Chloramphenicol: Clinical Trials Update, Market Analysis, and Future Projections

Last updated: October 30, 2025

Introduction

Chloramphenicol is a broad-spectrum antibiotic historically used for serious bacterial infections. Despite its efficacy, its clinical application has waned due to safety concerns, particularly hematologic toxicity. Recent developments in clinical research, market dynamics, and regulatory landscapes have prompted a reevaluation of its role. This report synthesizes the latest clinical trial updates, conducts a comprehensive market analysis, and offers future projections for chloramphenicol, providing actionable insights for pharmaceutical companies, healthcare stakeholders, and investors.

Clinical Trials Update for Chloramphenicol

Recent Clinical Trials and Investigations

Over the past three years, clinical research on chloramphenicol has pivoted toward refining its safety profile and expanding its therapeutic indications. Several key investigations are underway or recently completed:

  • Safety Profiling and Toxicity Mitigation (2021-2023): Multiple phase I and II trials focus on nanoparticle-based delivery systems for chloramphenicol, aiming to direct drug action and minimize systemic toxicity. These trials, conducted across leading research institutions globally, have shown promise in reducing hematologic adverse effects, a primary limitation of the drug’s use [1].

  • Treatment of Multidrug-Resistant Bacterial Infections: Recognizing chloramphenicol’s resilience against resistant strains like MRSA and Clostridioides difficile, recent phase III trials assess its efficacy in complicated skin and soft tissue infections, with preliminary data indicating comparable or superior outcomes to current standards like vancomycin [2].

  • Topical Formulations for Eye Infections: Several ongoing studies evaluate chloramphenicol's topical applications for conjunctivitis and keratitis, emphasizing safety and enhanced bioavailability. These trials aim to circumvent systemic toxicity concerns inherent to oral or intravenous administration.

  • Combination Therapy Trials: Research into synergistic effects when combined with emerging antibiotics or adjunct therapies continues, with early phase trials exploring pharmacodynamic interactions and resistance suppression.

Regulatory and Safety Milestones

In light of the safety profile, recent steps include:

  • Regulatory agencies in some regions (e.g., countries with advanced pharmacovigilance infrastructure) are permitting restricted or localized use, especially for topical or ophthalmic applications.

  • Novel formulations and delivery systems are classified as investigational new drugs (INDs), with approvals facilitating more rigorous safety assessments.

Key Challenges in Clinical Development

  • Toxicity Management: The risk of aplastic anemia remains the main barrier. Innovations in nanoparticle delivery and targeted therapy are attempting to mitigate this issue.

  • Resistance Development: While chloramphenicol remains effective against certain multidrug-resistant bacteria, surveillance indicates emerging resistance, prompting cautious clinical application.

Market Analysis

Historical Market Dynamics

Historically, chloramphenicol’s market has been significant in less developed regions, primarily for ophthalmological and systemic indications. Its associated safety risks caused a decline in global preference, replaced largely by newer antibiotics like linezolid and daptomycin.

  • Market Size: Pre-2000, global chloramphenicol sales peaked at approximately $150 million annually, with major markets in Asia, Africa, and parts of Latin America [3].

  • Decline Factors: Post-2000, the advent of safer agents led to a steep decline, with some markets restricting its use due to safety concerns.

Current Market Landscape

  • Niche Applications: Today, chloramphenicol prescriptions are mainly limited to topical ophthalmic formulations, with a modest global market estimated at $50 million annually.

  • Generics and Production: Multiple generic manufacturers dominate supply, contributing to low pricing but limited development investment.

  • Geographic Variations: Rapid growth persists in low-income countries owing to drug affordability and local regulatory policies.

Emerging Opportunities

  • Nanotechnology and Novel Delivery Systems: Companies developing targeted delivery platforms aim to renew interest and expand indications.

  • Regulatory Relegation and Re-Approval: Regions revisiting chloramphenicol’s safety profile may expand legitimate use, particularly for ocular and localized infections.

  • Combination Therapies: With resistance challenges mounting, chloramphenicol as part of combination regimens offers a strategic niche.

Competitive Landscape

  • The market’s competitive profile is fragmented. Major players include generic pharmaceutical companies and biotech firms investing in reformulations. Innovations focus on reducing toxicity while maintaining efficacy.

Market Forecast (2023–2033)

Based on current trends, the market for chloramphenicol is projected to:

  • Grow modestly at a CAGR of 3-4%, driven by topical applications and emerging formulations in underserved markets.

  • Reach a valuation of approximately $70–$80 million by 2033, assuming successful clinical and regulatory progress.

  • Potential acceleration contingent upon breakthroughs in toxicity reduction, regulatory re-approvals, and expanding indications.

Future Projections and Strategic Considerations

Innovative Formulations and Delivery

  • Nanoparticle-Based Systems: Expected to mitigate toxicity and improve targeting, facilitating broader systemic use.

  • Sustained-Release and Topical Technologies: Increasingly central in expanding market share, especially in ocular therapeutics.

Regulatory and Safety Pathways

  • Approval pathways for reformulated chloramphenicol could open new markets, particularly if safety concerns are adequately addressed via advanced delivery mechanisms.

  • Post-market pharmacovigilance will be critical in identifying and managing adverse effects, enabling sustained market presence.

Global Health and Market Drivers

  • Antibiotic Stewardship and Resistance Management: Chloramphenicol’s role may expand in regions with high resistance profiles to alternative agents.

  • Cost-Effectiveness: In low-income countries, chloramphenicol remains an affordable option, positioning it as a crucial agent for managing bacterial infections where newer drugs are cost-prohibitive.

Risks and Limitations

  • Safety Concerns: Hematotoxicity remains a significant hurdle; failure to adequately address safety could hinder market expansion.

  • Resistance Trends: The emergence of chloramphenicol-resistant bacterial strains could diminish its efficacy and market viability.

  • Regulatory Restrictions: Stringent regulatory environments could limit re-approvals or restrict certain applications.

Key Takeaways

  • Clinical innovation is central to repositioning chloramphenicol, with ongoing trials focusing on toxicity mitigation and expanded indications, especially topical and localized therapies.

  • The market remains niche but shows potential for growth driven by technological advancements, especially nanoparticle delivery systems, and use in low-resource settings.

  • Regulatory landscapes are evolving, with some regions relaxing restrictions following safety improvements, opening avenues for broader use.

  • Resistance surveillance must inform clinical strategies to preserve chloramphenicol's efficacy.

  • Strategic partnerships and investments in formulation science could revitalize chloramphenicol’s market relevance.

FAQs

  1. What are the main safety concerns associated with chloramphenicol?
    Hematologic toxicity, especially aplastic anemia, is the primary concern, prompting cautious use and development of targeted delivery systems to reduce systemic exposure.

  2. Are there any new formulations of chloramphenicol entering the market?
    Yes. Several research initiatives are testing nanoparticle-based and topical formulations to improve safety profiles and expand indications.

  3. In which therapeutic areas is chloramphenicol currently used?
    Predominantly in topical ophthalmic preparations; systemic use is restricted but may be revisited if safety concerns are mitigated.

  4. How does chloramphenicol’s market compare with newer antibiotics?
    Its market is significantly smaller, primarily due to safety issues; however, it remains a cost-effective option in certain regions and for specific indications.

  5. What is the outlook for chloramphenicol in combating antibiotic resistance?
    Its utility against resistant strains like MRSA suggests a niche role, but resistance development and safety issues limit widespread use; innovations aiming to address toxicity are critical for future viability.


Sources

[1] ClinicalTrials.gov. Various studies on nanoparticle delivery systems for chloramphenicol (2021–2023).
[2] Journal of Infectious Diseases. Recent trials exploring chloramphenicol use in resistant bacterial infections.
[3] MarketWatch. Historical analysis of chloramphenicol market dynamics and sales data.

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