Penicillin adverse reactions

Identify the uses, general drug actions, and general adverse reactions, contraindications, precautions, and interactions of the penicillins. 

Common adverse reactions include mild nausea, vomiting, diarrhea, sore tongue or mouth, fever, and pain at injection site. Penicillin can stimulate a hypersen-... 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

The expected outcomes of the patient depend on the reason for administration of penicillin but may include an optimal response to drug therapy, management of common adverse reactions, and an understanding of and compliance with the prescribed drug regimen. 

The well-known adverse reaction formerly often observed after intramuscular injection of clemizol penicilUn in the treatment of syphilis with anaphylaxis-like symptoms plus CNS involvement in the absence of immimological sensitization to penicillin was called the Hoigne syndrome or embolic-toxic reaction, and might be explained by intravasal appUcation of LA with subsequent toxic effects [8]. 

The answer is b. (Hardman, p 1077.) Oxacillin is classified as a penicillinase-resistant penicillin that is relatively acid-stable and, therefore, is useful for oral administration. Major adverse reactions include penicillin hypersensitivity and interstitial nephritis. With the exception of methi-cillin, which is 35% bound to serum proteins, all penicillinase-resistant penicillins are highly bound to plasma proteins. Oxacillin has a very narrow spectrum and is used primarily as an anti staphylococcal agent... 

A native of England, Roy Bolbery, forty-two when interviewed, was ill throughout his childhood in London. At age six he had a severe adverse reaction to penicillin. His sleep frequently was interrupted by night terrors. And during the day he would suddenly feel ill for no apparent reason. The outcome of many medical tests was a diagnosis of mild epilepsy. His sister died in childhood of leukemia. His father suffered with tuberculosis. 

Hematologic/Lymphatic Anemia hemolytic anemia thrombocytopenia thrombocytopenic purpura eosinophilia leukopenia granulocytopenia neutropenia bone marrow depression agranulocytosis reduction of hemoglobin or hematocrit prolongation of bleeding and prothrombin time decrease in WBC and lymphocyte counts increase in lymphocytes, monocytes, basophils, and platelets. Hypersensitivity Adverse reactions (estimated incidence, 1% to 10%) are more likely to occur in individuals with previously demonstrated hypersensitivity. In penicillin-sensitive individuals with a history of allergy, asthma, or hay fever, the reactions may be immediate and severe. 

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. 

Blood dyscrasias, mostly dose independent, are among the most important allergic-type adverse reactions to drugs. Aplastic anemia is a serious but rare (presumably) idiosyncratic reaction. It has been reported in association with chloramphenicol, quinacrine, phenylbutazone, mephenytoin, gold compounds, and potassium chlorate. Hemolytic anemia, thrombocytopenia, and agranulocytosis may result from an unusual, acquired sensitivity to a variety of widely used drugs including aminopyrine, phenylbutazone, phenothiazines, propylthiouracil, diphenylhydantoin, penicillins, chloramphenicol, sulfisoxazole, and tolbutamide. 

It has long been known that intramuscular procaine penicillin can cause some peculiar psychological adverse reactions, and that other penicillin derivatives, such as amoxicillin, can cause psychiatric reactions, such as hallucinations (SEDA-21, 259). In a report from the Netherlands, neuropsychiatric symptoms occurred in six patients who received cefepime for febrile neutropenia (147). The patients, two men and four women, aged 32-75 years, received 6 g/day (n = 5) or 3 g/day (n = 1). 

Adverse reactions to drugs will be more instantaneous and serious, too (example penicillin allergy)... 

The major adverse reactions to the penicillins are hypersensitivity responses. Manifestations of hypersensitivity inclnde nrticaria, angioedema, and anaphylaxis (type 1 reaction) hemolytic anemia (type 11 reaction) interstitial nephritis, vascnlitis, and serum sickness (type 111 reaction) and contact dermatitis or Stevens-Johnson syndrome (type IV reaction). A maculopapular rash occnrs late in the treatment course of 2% to 3% of patients receiving a penicillin drug. Once a patient has had a hypersensitivity response to a penicillin, it is probable, bnt not certain, that a reaction will occur with exposure to the same penicillin or to any other penicillin. Intradermal skin tests can predict whether a patient is at risk for developing a hypersensitivity reaction to the penicillins. If the resnlts are positive, penicillins should generally be avoided. 

As with the penicillins, hypersensitivity reactions are the most common systemic adverse events caused by cephalosporins. Maculopapular rash, urticaria, fever, bron-chospasm,and anaphylaxis have been associated with the use of cephalosporins.Because the molecular structure of the penicillins and the first-generation cephalosporins are similar, there is a risk in patients who are aUergic to penicillin to manifest aUergic cross-reactions when prescribed any of this gronp of cephalosporins. In contrast, the risk of cross-reactivity between the penicUUns and the second-, third-, and fonrth-generation cephalosporins has been overestimated, and patients with a previons aUergic... 

In contrast to hypersensitivity, other adverse reactions do not require sensitization and require similar doses of drug for recurrence. A special case is a syndrome (Hoigne s syndrome) that resembles an immediate allergic reaction combined with hallucinations, aggressive behavior, anxiety, and auditory and visual disturbances, which has been described after intramuscular procaine penicUhn and benzathine penicillin. It is probably due to accidental intravascular injection and results from micro-embohsm of the penicUhn depot formulation (271-275). 

Neftel KA, Walti M, Schulthess HK, Gubler J. Adverse reactions following intravenous penicillin-G relate to degradation of the drug in vitro. Klin Wochenschr 1984 62(l) 25-9. 

Fellner MJ. Adverse reactions to penicillin and related drugs. Clin Dermatol 1986 4(1) 133-41. 

In one case of tubulointerstitial nephritis and nephrotic syndrome induced by Triazolam, a sleep inducer numerous eosinophils [85] were found to infiltrate glomeruli and interstitium suggesting that eosinophils may be pathogenic in this situation. An association with tubulointerstitial nephritis and nephrotic syndrome has also been occasionally reported for penicillin/ amoxicillin induced nephropathies [86]. Several reports have analyzed T-cells in penicillin-induced allergy. CD4 T-cells specific for penicillin may be derived from the patients and produce mainly lL-5, some of them being perforin positive with a cytolytic potential [87]. 2) P-lactam specific clones may be obtained only from patients with adverse reactions the clones were Th2 whatever the type of clinical manifestations and... 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

Chapman C, Courage P, Nielsen I et al 1992 The role of procaine in adverse reactions to procaine penicillin in horses. Australian Veterinary Journal 69 129-133... 

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