Infection MHRA alerts

Question 1

Gentamicin

Answer 1

Potential for histamine-related ADRs with some batches

Particular caution is required in patients taking concomitant drugs known to cause histamine release, in children, and in patients with severe renal impairment.

Question 2

Aminglycosides

Answer 2

Increased risk of deafness in patients with mitochondrial mutations

Question 3

Flucloxacillin

Answer 3

Hepatic disorders e.g. cholestatic jaundice and hepatitis (can occur up to 2mo after stopping treatment)

Risk factors include:

• administration for 2 weeks+
• increasing age
• Should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin
• used with caution in patients with hepatic impairment
• careful enquiry should be made about hypersensitivity reactions to beta-lactam antibacterials

Question 4

Quinolones (1)

Answer 4

May induce convulsions in patients with or without a history of convulsions

Taking NSAIDs at the same time may also induce them.

Question 5

Quinolones (2)

Answer 5

Tendon damage (including rupture)

It may occur within 48 hours of starting treatment but also maybe several months after stopping a quinolone.

Contraindicated in patients:
- with a history of tendon disorders related to quinolone use

Patients over 60 are more prone of tendon damage

The risk of tendon damage is increased by the concomitant use of corticosteroids

If tendonitis is suspected the quinolone should be discontinued immediately.

Question 6

Linezolid (1)

Answer 6

Optic neuropathy (esp if used longer than 28 days). Monitor visual function if treatment duration exceeds 28 days.

Advise patients to report side effects.

Question 7

Linezolid (2)

Answer 7

Haematopoietic disorders (including thrombocytopenia, anaemia, leucopenia, and pancytopenia)

Measure FBCs weekly, especially in patients:

• receive treatment for more than 10–14 days
• have pre-existing myelosuppression
• are receiving drugs that may have adverse effects on haemoglobin, blood counts, or platelet function
• severe renal impairment

Question 8

Itraconazole

Answer 8

Heart Failure (cautions, bnf)

Manufacturer advises avoid in patients with ventricular dysfunction, such as history of congestive heart failure, unless the infection is serious.

Question 9

Chloroquine

Answer 9

In adults: ocular toxicity is unlikely if the dose of chloroquine phosphate does not exceed 4mg/kg daily (equivalent to chloroquine base approx 2.5mg/kg daily).

Question 10

Quinine

Answer 10

Dose-dependant QT prolonging effects

Question 11

Direct-acting antivirals (1)

Answer 11

Direct-acting antivirals interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation

Question 12

Direct-acting antivirals (2)

Answer 12

Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in patients with diabetes

To monitor glucose levels closely in patients with diabetes during direct-acting antiviral therapy for hepatitis C, especially within the first 3 months of treatment and modify diabetic medication or doses when necessary

To be vigilant for changes in glucose tolerance and advise patients for the risk of hypoglycemia

To inform the healthcare professional in charge of the diabetic care of the pateint when direct-acting antiviral therapy is initiated.

Question 13

Dolutegravir

Answer 13

Smaller risk of neural tube defects than previously thought

Counsel women on contraception and possible risks

Question 14

Elvitegravir with cobicistat and Darunavir with cobicistat

Answer 14

Avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1