Antibiotics adverse reactions

Doxycycline (Vibramycin) is an antibiotic belonging to die tetracycline group of antibiotics. The adverse reactions associated with this drug are discussed in Chapter 9 and include photosensitivity, anorexia, nausea, and vomiting. 

The antibiotic and sulfonamide ophthalmics are usually well tolerated, and few adverse reactions are seen. Occasional transient irritation, burning, itching, stinging, inflammation, or blurring of vision may occur. With prolonged or repeated use, a superinfection may occur. 

Which of the following adverse reactions would the nurse suspect in a patient receiving prolonged treatment with an antibiotic otic drug ... 

Adverse reactions to drugs differ in both type and incidence in the pediatric population. Because of immature metabolic pathways, infants and children may have different metabolic patterns than adults. This at least partially explains why neonates require lower theophylline serum concentrations for the treatment of neonatal apnea and why the incidence of hepatotoxi-city following acetaminophen overdose is much lower in young children than in adults [44,45]. Antibiotic adverse effects unique to the pediatric population may... 

In patients, who experienced a clinical exacerbation of UC and who had a past history of serious adverse reactions to steroids, the antibiotic (400 mg b.i.d. for 4 weeks) was added to mesalazine (2.4 g daily) treatment [49]. In 7 out of 10 patients (i.e. 70%) a clinical remission was achieved without corticoid use, thus showing that rifaximin displays a steroid-sparing effect. 

Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse reactions. 

C. Pyrazinamide is known to cause hyperuricemia and precipitate gouty arthritis. Pyrazinamide-induced gouty arthritis does not respond to uricosuric therapy with probenecid but may respond to acetylsalicylic acid. Cycloserine (A) can cause headaches, confusion, tremors, and seizures, possibly secondary to low levels of magnesium in the cerebrospinal fluid cycloserine should be avoided in patients with epilepsy and mental depression. It is not associated with hyperuricemia. Thiacetazone (B) is an antibiotic that is rarely used in tuberculosis. The most common adverse reactions are general rashes and GI intolerance. Its use is not associated with hy-... 

Polymyxin B is effective against many gramnegative bacteria, including E. coli, Klebsiella, and Salmonella. Systemic administration of this drug, however, is often associated with extreme nephrotoxicity. Hence, this agent is used primarily for the treatment of local, superficial infections of the skin, eyes, and mucous membranes. When applied topically for these conditions, adverse reactions are relatively rare. Polymyxin B is often combined with other antibiotics such as bacitracin and neomycin in commercial topical preparations. 

The penicillins [pen i SILL in] are the most widely effective antibiotics and are among the least toxic drugs known the major adverse reaction to penicillins is hypersensitivity. The members of this family differ from one another in the R substituent attached to the 6-aminopenicillanic acid residue. The nature of this side chain affects their antimicrobial spectrum, stability to stomach acid, and susceptibility to bacterial degradative enzymes (P-lactamases). Figure 30.1 shows the main structural features of the penicillins. Figure 30.2 shows the classification of agents affecting cell wall synthesis. 

Introduction of the first fluorinated quinolone, norfloxacin [nor FLOX a sin], has been rapidly followed by new members of this class. These agents are totally synthetic and are closely related structurally to an earlier quinolone, nalidixic acid [nal i DIX ik]. The principal member of this group is ciprofloxacin [sip ro FLOX a sin], which has the widest clinical application. Other antibiotics in this group available in the United States are primarily employed to treat urinary infections (Figure 32.1). It seems likely that the size of this class of antibiotics will increase due to its wide antibacterial spectrum, favorable pharmacokinetic properties and relative lack of adverse reactions. Unfortunately, their overuse has already led to the emergence of resistant strains resulting in limitations to their clinical usefulness. 

Upon systemic distribution, many drugs evoke skin reactions that are caused on an immunological basis. Moreover, cutaneous injury can also arise from nonimmunological mechanisms. Cutaneous side effects vary in severity from harmless to lethal. Cutaneous reactions are a common form of drug adverse reaction. Nearly half of them are attributed to antibiotics or sulfonamides, and one-third to nonsteroidal anti-inflammatory agents, with many other pharmaceuticals joining the list... 

The American Academy of Pediatrics recommends that doxycycline not be used in children less than 9 years of age because of retarded skeletal growth in infants and discolored teeth in infants and toddlers (Inglesby et al., 2002). Because of the serious nature of anthrax infection, however, Inglesby and colleagues (2002) recommend that doxycycline, instead of ciprofloxacin, be used in children if antibiotic susceptibility testing, exhaustion of drug supplies, or adverse reactions preclude the use of ciprofloxacin. 

Adverse reactions. Heartburn, nausea and vomiting due to gastric irritation are common, and attempts to reduce this with milk or antacids impair absorption of tetracyclines (see below). Loose bowel movements occur, due to alteration of the bowel flora, and this sometimes develops into diarrhoea and opportunistic infection (antibiotic associated or pseudomembranous colitis) may supervene. Disorders of epithelial surfaces, perhaps due partly to vitamin B complex deficiency and partly due to mild opportunistic infection with yeasts and moulds, lead to sore mouth and throat, black hairy tongue, dysphagia and perianal soreness. Vitamin B preparations may prevent or arrest alimentary tract symptoms. 

The most prominent adverse reaction of the lincosamides is diarrhea, which varies from mildly loose bowel movements to life-threatening pseudomembranous colitis (see monograph on Beta-lactam antibiotics). Almost all antimicrobial drugs have been associated with severe diarrhea and colitis however, lincomycin and clindamycin have been particularly incriminated. The incidence of clindamycin-induced diarrhea in hospital is 23%. Diarrhea resolves promptly after withdrawal in most cases. It seems to be dose-related and may result from a direct action on the intestinal mucosa. Severe colitis due to C. difficile is not dose-related and occurs in 0.01-10% of recipients. Clustering of cases in time and place suggests the possibility of cross-infection. Even low doses of clindamycin, in some cases after topical administration, can cause marked alterations in several intestinal functions related to bowel flora (23). There was reduced susceptibility of C. difficile to clindamycin in 80% of French isolates in 1997 (24). Lincomycin was among the antibiotics that were most often associated with the development of antibiotic-associated diarrhea in a Turkish study of 154 patients other associated antibiotics were azithromycin and ampicillin (25). 

Table 1 Frequencies of adverse reactions to macrolide antibiotics...

---