Hypersensitivity antibiotic

The effectiveness of chemotherapy is enhanced by adequate immune function however, some antibiotics suppress immune function. For example, tetracychnes can decrease leukocyte chemotaxis and complement activation. Rifampin decreases the number of T lymphocytes and depresses cutaneous hypersensitivity. Antibiotics such as the sulfonamides may induce granulocytopenia or bone marrow aplasia. These effects are not well understood but may be due to enteric bacterial metabohc byproducts of these antibiotics. 

As with all drugs, the specific side effects of the quinolones must be considered when they are chosen for treatment of bacterial infections [5]. Reactions of the gastrointestinal tract and the central neivous system are the most often observed adverse effects during therapy with quinolones. It should be underlined, however, that compared with many other antimicrobials, diarrhea is less frequently observed during quinolone treatment. Antibiotic-associated colitis has been observed rarely during quinolone therapy. Similarly, hypersensitivity reactions, as observed during therapy with penicillins and other (3-lactams, is less frequently caused by quinolones. Some other risks of quinolone therapy have been defined and must be considered if a drug from this class is chosen for treatment of bacterial infections. 

Discuss hypersensitivity reactions and pseudomembranous colitis as they relate to antibiotic therapy. 

The antibiotic and sulfonamide ophthalmics are contraindicated in patients with a hypersensitivity to the drug or any component of the drug. These dru are also contraindicated in patients with epithelial herpes simplex keratitis, varicella, mycobacterial infection of the eye, and fungal diseases of the eye There are no significant precautions or interactions when the dru are administered as directed by the primary health care provider. 

Hypersensitivity reactions with P-lactam antibiotics, especially penicillin, may encompass any of the type I through IV Gell-Coombs classifications. The most common reactions are maculopapular and urticarial eruptions.7 While rare (less than 0.05%), anaphylaxis to penicillins causes the greatest concern because they are responsible for the majority of drug-induced anaphylaxis deaths in patients, accounting for 75% of all ana-i phylaxis cases in the United States.5,8 The treatment of ana-I phylaxis is given in Table 51-2.9... 

FIGURE 69-3. Treatment algorithm3 for acute bacterial rhinosinusitis in patients with mild disease without recent antibiotic exposure.31 aAntibiotics are listed in order of predicted efficacy based on predicted clinical and bacteriologic efficacy rates, clinical studies, safety, and tolerability. Doses can be found in Table 69-4. 6Cephalosporins should be considered for patients with non-type I hypersensitivity to penicillins they are more likely to be effective than the alternative agents. cHigh doses (90 mg/kg per day) are recommended for most children, especially those with day-care contacts or frequent infections. 

Monitor the patient for the development of potential complications of treatment such as delayed hypersensitivity reactions, antibiotic-induced diarrhea, pseudomembraneous colitis, or fungal superinfections (manifested as oral thrush). 

Acute drug-related hypersensitivity reactions (allergic responses) may cause tubulointerstitial nephritis, which will damage the tubules and interstitium. These reactions are most commonly observed with administration of methicillin and other synthetic antibiotics as well as furosemide and the thiazide diuretics. The onset of symptoms occurs in about 15 days. Symptoms include fever, eosinophilia, hematuria (blood in the urine), and proteinuria (proteins in the urine). Signs and symptoms of acute renal failure develop in about 50% of the cases. Discontinued use of the drug usually results in complete recovery however, some patients, especially the elderly, may experience permanent renal damage. 

Penicillin G 24 million units/24 h IV in four to six equally divided doses may be used in place of nafcillin or oxacillin if strain is penicillin susceptible (minimum inhibitory concentration 0,1 mcg/mL) and does not produce /5-lactamase vancomycin should be used in patients with immediate-type hypersensitivity reactions to beta-lactam antibiotics (see Table 37-3 for dosing guidelines) cefazolin may be substituted for nafcillin or oxacillin in patients with non-immediate-type hypersensitivity reactions to penicillins... 

Cefazolin is the best-studied antibiotic and is thus the drug of choice. For hip fracture repairs and joint replacements, it should be administered for 24 hours. Vancomycin is not recommended unless a patient has a history of /3-lactam hypersensitivity or the propensity for MRSA infection at the institution necessitates its use. 

Weiss, M.E. and Adkinson, N.F., Immediate hypersensitivity reactions to penicillin and related antibiotics, Clin. Allergy, 18, 515, 1988. 

Antibiotics Cephalosporins Chloramphenicol Neomycin Sulfathiazole Spiramycin Quinolones Tetracyclines Hypersensitivity Anaphylaxis, urticaria, rash, granulocytopenia Rash, dermatitis, urticaria Dermal exposure-rash, dermatitis Rash, dermatitis, urticaria Rash, dermatitis, urticaria Photosensitivity Photosensitivity, anaphylaxis, asthma, dermatitis... 

Antibiotics Isoniazid Penicillins Hypersensitivity and Autoimmunity Rash, dermatitis, vasculitis, arthritis, drug-induced SLE Anaphylaxis, dermatitis vasculitis, serum sickness, hemolytic anemia... 

Kobierski LA, Abdi S, DiLorenzo L, Eeroz N, Borsook D. (2003) A single intravenous injection of km5500 (antibiotic spicamycin) produces longterm decreases in multiple sensory hypersensitivities in neuropathic pain. Anesth Analg 97 174-182. 

Hypersensitivity reactions Make careful inquiry for a history of hypersensitivity reactions. Monitor patients who have had immediate hypersensitivity reactions to penicillins or cephalosporins. If an allergic reaction occurs, discontinue the drug and institute supportive treatment. Cross-sensitivity with other penicillins or -lactam antibiotics is rare. 

Pseudomembranous colitis Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range in severity from mild to life-threatening. Hypersensitivity reactions Administer tigecycline with caution to patients with known hypersensitivity to tetracycline class antibiotics. 

Hypersensitivity to any of the macrolide antibiotics patients receiving cisapride or pimozide known, suspected, or potential bacteremias (dirithromycin) preexisting liver disease (erythromycin estolate). 

A history of hypersensitivity to telithromycin and/or any components of the product or any macrolide antibiotic. Coadministration of telithromycin with cisapride or pimozide is contraindicated. 

Polymyxin B sulfate, a polypeptide antibiotic, is effective against gram-negative organisms. Hypersensitivity to topically applied polymyxin is rare. To reduce the likelihood of neurotoxicity and nephrotoxicity the total daily dose applied to the denuded skin or to open wounds should not exceed 200 mg. 

Topical tetracyclines are sometimes used to treat acne and minor superficial pyogenic infections of the skin. Patients hypersensitive to one member of this class of antibiotics may also be hypersensitive to other tetracyclines. Photosensitization may occur. 

Topical formulations of nystatin and of amphotericin B are useful in the management of Candida albicans infections of the skin. Both antibiotics are ineffective against dermatophytes. The use of nystatin is limited to topical treatment of cutaneous and mucosal Candida infections because of its narrow spectrum and its negligible absorption from the gastrointestinal tract. Hypersensitivity reactions are rare. It is not known whether topical nystatin can cause fetal harm when used by a pregnant woman. Amphotericin B has broader antifungal activity but its topical use is restricted to Candida. Topical use of amphotericin B has shown minimal absorption through the skin and is well tolerated. Limited human surveillance data do not indicate any harm to mother or fetus, but relative safety is still unknown. 

The incidence of nonallergic ampicillin eruptions is 40 to 100% in patients with concomitant Epstein-Barr virus (mononucleosis), cytomegalovirus, acute lymphocytic leukemia, lymphoma, or reticulosarcoma. Nonallergic penicillin-associated rashes are characteristically morbilliform (symmetrical, erythematous, confluent, maculopapular) eruptions on the extremities. The onset of typical nonallergic eruptions is more than 72 hours after (3-lactam exposure. The mechanism for the nonurticarial ampicillin rash is not known and is not related to IgE or type I hypersensitivity. Penicillin skin tests are not useful in the evaluation of nonurticarial ampicillin rashes. Patients with a history of nonurticarial ampicillin rashes may receive other (3-lactam antibiotics without greater risk of subsequent serious allergic reactions. 

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. 

Erythromycin is effective in the treatment and prevention of S. pyogenes and other streptococcal infections, but not those caused by the more resistant fecal streptococci. Staphylococci are generally susceptible to erythromycin, so this antibiotic is a suitable alternative drug for the penicillin-hypersensitive individual. It is a second-line drug for the treatment of gonorrhea and syphilis. Although erythromycin is popular for the treatment of middle ear and sinus infections, including H. influenzae, possible erythromycin-resistant S. pneumoniae is a concern. 

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