Antibiotics with neuromuscular blocking

In very high doses or in sensitive patients (for example in myasthenia), antibiotics can produce paralysis and act addi-tively or synergistically with neuromuscular blocking drugs. 

Singh YN, Marshall IG, Harvey AL. The mechanisms of the muscle paralysing actions of antibiotics and their interaction with neuromuscular blocking agents. Rev Drng Metab Drug Interact 1980 3 129. 

Procainamide has been reported to increase the effects of suxamethonium in animals, increase muscle weakness in a myasthenic patient, and reduce plasma cholinesterase activity in healthy subjects. An animal study demonstrated potentiation of the neuromuscular blocking effect of tubocurarine by lidocaine alone and combined with antibiotics having neuromuscular blocking activity (neomycin or polymyxin B). ... 

Clindamycin Solutions of clindamycin salts are incompatible with alkaline doses or other drugs that are unstable at low pH. Clindamycin phosphate is not compatible with some rubber packing materials. pH-dependent degradation was reported with clindamycin, and phosphate salt was found to be most stable. Therapy with clindamycin should be stopped if diarrhea or colitis are found. The patient should be treated with other antibiotics. Clindamycin potentiates the actions of neuromuscular-blocking agents, opioids, and the antagonistic action of parasympathomimetics. 

Aminoglycoside antibiotics produce neuromuscular blockade by inhibiting ACh release from the preganglionic terminal (through competition with Ca ) and to a lesser extent by noncompetitively blocking the receptor. Tetracyclines also can produce neuromuscular blockade, possibly by chelation of Ca. Additional antibiotics that have neuromuscular blocking action, through both presynaptic... 

The concomitant use of antibiotics, including the polymyxins, tetracyclines and the aminoglycosides with the non-depolarizing neuromuscular blocking agents has occasionally resulted in prolonged muscular... 

---