Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 11)

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Adverse Reactions Adverse drug reactions are frequently classified by mechanism as either dose-related ("toxic") or unpredictable. Unpredictable reactions are either idiosyncratic or allergic. Dose-related reactions include aminoglycoside-induced nephrotoxicity, linezolid-induced thrombocytopenia, penicillin-induced seizures, and vancomycin-induced anaphylactoid reactions. Many of these reactions can be avoided by reducing dosage in patients with impaired renal function, limiting the duration of therapy, or reducing the rate of administration. Adverse reactions to antibacterial agents are a common cause of morbidity, requiring alteration in therapy and additional expense, and they occasionally result in death. The elderly, often those with the more severe infections, may be especially prone...

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Nội dung Text: Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 11)

Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 11) Adverse Reactions Adverse drug reactions are frequently classified by mechanism as either dose-related ("toxic") or unpredictable. Unpredictable reactions are either idiosyncratic or allergic. Dose-related reactions include aminoglycoside-induced nephrotoxicity, linezolid-induced thrombocytopenia, penicillin-induced seizures, and vancomycin-induced anaphylactoid reactions. Many of these reactions can be avoided by reducing dosage in patients with impaired renal function, limiting the duration of therapy, or reducing the rate of administration. Adverse reactions to antibacterial agents are a common cause of morbidity, requiring alteration in therapy and additional expense, and they occasionally result in death. The elderly, often those with the more severe infections, may be especially prone to certain adverse reactions. The most clinically relevant adverse reactions to common
antibacterial drugs are listed in Table 127-7. For further discussion of adverse drug reactions, see Chap. 5. Table 127-7 Most Clinically Relevant Adverse Reactions to Common Antibacterial Drugs Drug Adverse Event Comments β-Lactams Allergies in ~1– Cephalosporin 4% of treatment courses s cause allergy in 2– 4% of penicillin- allergic patients. Aztreonam is safe in β-lactam–allergic patients. Nonallergic skin Ampicillin reactions "rash" is common among patients with Epstein-Barr virus infection.
Diarrhea, — including Clostridium difficile colitis (Chap. 123) Vancomycin Anaphylactoid Give as a 1- to reaction ("red man 2-h infusion. syndrome") Nephrotoxicity, Rare ototoxicity, allergy, neutropenia Aminoglycosides Nephrotoxicity Greatest with (generally reversible) prolonged therapy in the elderly or with preexisting renal insufficiency. Monitor serum creatinine every 2–3
days. Ototoxicity Risk factors (often irreversible) similar to those for nephrotoxicity; both vestibular and hearing toxicities Macrolides/ketolides Gastrointestinal Most common distress with erythromycin Ototoxicity High-dose IV erythromycin Cardiac toxicity QTc prolongation and torsades de pointes, especially when inhibitors of erythromycin metabolism are given
simultaneously Hepatic toxicity Warning (telithromycin) added to prescribing information (July 2006) Respiratory Warning failure in patients with added to prescribing myasthenia gravis information (July (telithromycin) 2006) Clindamycin Diarrhea, — including C. difficile colitis Sulfonamides Allergic reactions Rashes (more common in HIV- infected patients); serious dermal reactions, including
erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis Hematologic Uncommon; reactions include agranulocytosis and granulocytopenia (more common in HIV-infected patients), hemolytic and megaloblastic anemia, thrombocytopenia Renal Crystalluria insufficiency with sulfadiazine therapy Fluoroquinolones Diarrhea, —
including C. difficile colitis Contraindicated Appear safe in for general use in treatment of patients
discoloration of urine and body fluids Miscellaneous: Uncommon; flu-like symptoms, usually related to hemolysis, renal intermittent insufficiency administration Metronidazole Metallic taste Common Tetracyclines/glycylcycline Gastrointestinal Up to 20% s distress with tigecycline Esophageal Doxycycline ulceration (take in A.M. with fluids) Linezolid Myelosuppressio Follows long- n term treatment Ocular and Follow long-
peripheral neuritis term treatment Daptomycin Distal muscle Weekly pain or weakness creatine phosphokinase measurements, especially in patients also receiving statins