Neuromuscular blocking agent antibiotics

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. 

Myasthenia gravis is made worse by quinine and quinidine and myasthenics are intolerant of competitive neuromuscular blocking agents and aminoglycoside antibiotics. 

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. 

C2iH39NtO,2 581.579 Aminoglycoside antibiotic. Isol. from Streptomyces griseus. Clinically used broad spectrum antibacterial (tuberculostatic) agent. Neuromuscular blocking agent. Phospholipase D inhibitor. Sol. H2O fairly sol. MeOH poorly sol. butanol, hexane. Log P -7.17 (uncertain value) (calc). Indefinite Mp. 

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... 

If it is suspected that an antibiotic is contributing to prolonged neuromuscular blockade, the patient should be monitored and the effect of calcium (up to 1 g of calcium chloride slowly) should be observed. If this is unsuccessful, neostigmine (maximum dose 5 mg for an adult) or edrophonium (0.5 mg/kg) can be tried, but these agents may intensify a block due to cohstin, lincomycin, or polymyxin B. If the other remedies fail, 4-aminopjTidine (maximum dose 0.3 mg/kg) can be successful. Artificial ventilation should be continued until adequate spontaneous efforts are achieved and other possible factors, such as acidosis or electrolyte disturbances, are corrected. 

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