Is chloramphenicol a first line antibiotic?

Chloramphenicol is generally not regarded as a first-line antibiotic in most clinical settings due to its potential for serious adverse effects such as bone marrow suppression and aplastic anemia, which restrict its routine empirical use. It is a broad-spectrum bacteriostatic antibiotic that acts by inhibiting bacterial protein synthesis, showing effective activity against a wide range of Gram-positive, Gram-negative bacteria, and some anaerobic pathogens, as well as certain intracellular microorganisms like Rickettsia. Clinically, it is mostly reserved as a second-line or alternative agent for severe infections where safer options are ineffective or unsuitable, such as certain typhoid fever cases, rickettsial diseases, and serious bacterial infections of the central nervous system, while topical formulations are commonly used for superficial eye and skin infections with a more favorable safety profile.

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