Worldwide variation in chloramphenicol utilization: should it cause concern?

Per capita sales of chloramphenicol in Hong Kong (which presumably reflect adult and pediatric consumption in the community) are between about 11 to 442 fold greater than in several western countries and Australia. Despite such relatively excessive exposure to a potentially marrow-damaging drug, the certified death rate from aplastic anemia in Hong Kong was only 0.4 per 1000 deaths compared with 1.0 per 1000 in England and Wales. Nor was there any other evidence to indicate that Hong Kong residents suffered an excessive incidence of aplastic anemia. Wherever chloramphenicol use is widespread, prospective investigations should be undertaken in the local population to evaluate the alleged high risks of producing aplastic anemia.