Aminoglycosides hypersensitivity reactions

Like the other anti-infectives, bacterial or fungal superinfections and pseudomembranous colitis (see Chap. 7) may occur with the use of these drags. The administration of the aminoglycosides may result in a hypersensitivity reaction, which can range from mild to severe and in some cases can be life threatening. Mild hypersensitivity reactions may only require discontinuing the drug, whereas the more serious reactions require immediate treatment. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

The primary adverse effect of intravenous cidofovir is a dose-dependent nephrotoxicity. Concurrent administration of other potentially nephrotoxic agents (eg, amphotericin B, aminoglycosides, nonsteroidal anti-inflammatory drugs, pentamidine, foscarnet) should be avoided. Prior administration of foscarnet may increase the risk of nephrotoxicity. Other potential side effects include uveitis, decreased intraocular pressure, and probenecid-related hypersensitivity reactions. Neutropenia and metabolic acidosis are rare. The drug caused mammary adenocarcinomas in rats and is embryotoxic. 

The main adverse reactions of aminoglycosides consist of kidney damage (often presenting as non-ohguric renal insufficiency) and ototoxicity, including vestibular and/ or cochlear dysfunction. Neuromuscular transmission can be inhibited. Hypersensitivity reactions are most frequent after topical use, which should be avoided. Anaphylactic reactions can occur. Tumor-inducing effects have not been reported. 

Yung MW, Rajendra T. Delayed hypersensitivity reaction to topical aminoglycosides in patients undergoing middle ear surgery. Clin Otolaryngol Allied Sci 2002 27(5) 365-8. 

Patients treated for intraabdominal infections should be assessed for the occurrence of drug-related adverse effects, particularly hypersensitivity reactions (/ -lactam antimicrobials), diarrhea (most agents), fungal infections (most agents), and nephrotoxicity (aminoglycosides). 

Hypersensitivity reactions, primarily skin rashes, occur in 6 to 8% of patients when neomycin is applied topically. Individuals sensitive to this agent may develop cross-reactions when exposed to other aminoglycosides. The most important toxic effects of neomycin are renal damage and nerve deafness this is why the drug is no longer available for parenteral administration. Toxicity has been reported in patients with normal renal function after topical application or irrigation of wounds with 0.5% neomycin solution. Neuromuscular blockade with respiratory paralysis also has occurred after irrigation of wounds or serosal cavities. 

Aztreonam may be used as a substitute for an aminoglycoside in the treatment of infections caused by susceptible gram-negative organisms. Most of the adverse effects of aztreonam are local reactions at the site of injection. Interestingly, aztreonam rarely causes allergic reactions in patients with a history of type I hypersensitivity to other (3-lactam antibiotics. 

Contraindication History of hypersensitivity or serious toxic reaction to aminoglycosides ... 

Because of dieir extreme nephrotoxicity, diese drugs are rarely if ever used except topically. Polymyxin B applied to intact or denuded skin or mucous membranes produces no systemic reactions because of its almost complete lack of absorption. Hypersensitization is uncommon with topical use. Neurological reactions include muscle weakness and apnea, paresthesias, vertigo, and slurred speech. Polymyxins are nephrotoxic, and coadministration with aminoglycosides should be avoided... 

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