Side Effects of Abx (related to Teng lecture)

Question 1

Penicillins

Answer 1

• Allergic reactions (anaphylaxis: SJS, TEN, shock, hypotension, bronchoconstriction etc)
• CDAD (aminopenicillins)
• hepatotoxicity
• anosmia
• seizures in pts with renal failure (high dose)
• neurotoxicity (confusion, hallucinations, convulsions)

Question 2

Cephalosporins

Answer 2

• hypersensitivity (cross-sensitivity with penicillin if share same R1 side chain)
• thrombophlebitis (give slowly, in diluted form, rotate infusion site)
• GI (CDAD, diarrhoea with PO)

Question 3

Carbapenem

Answer 3

• neurotoxicity (seizure)
• rash
• GI (N/V/D)
• cross-hypersensitivity with penicillin

Question 4

Vancomycin

Answer 4

• thrombophlebitis with fever, chills
• red man syndrome (prolong duration of infusion to 1-2h)
• ototoxicity & nephrotoxicity

Question 5

Doxycycline

Answer 5

• GI (oesophageal irritation -> drink with full cup of water, stay upright for 30min, space apart from ions by 2h)
• discolouration of teeth
• hepatotoxicity
• phototoxicity
• superinfection (if use >2m)

C/I: pregnant, <8y, myasthenia gravis

Question 6

Aminoglycosides

Answer 6

• nephrotoxicity & ototoxicity
• neuromuscular paralysis (concurrent adm with neuromuscular blockers)

Question 7

Macrolides

Answer 7

• hepatotoxicity
• ototoxicity
• QTc prolongation
• GI (gastric upset, less with C & A)

Question 8

Clindamycin

Answer 8

• GI (D/V, oesophageal irritation -> take with full glass of water)
• skin rash
• CDAD

Question 9

Linezolid

Answer 9

• GI (N/D)
• headache
• rash
• bone marrow suppression (thrombocytopenia if take for >10D -> monitor blood count)
• serotonin syndrome (concurrent adm with selective serotonin reuptake inhibitors / MAO inhibitors)
• irreversible peripheral neuropathies & optic neuritis (if take for >28D)

C/I: within 2 weeks of MAO inhibitors, tx of catheter-related bloodstream infx / catheter-site infx

Question 10

Fluoroquinolones

Answer 10

• GI (N/V/D, give 2h before or 6h after ions)
• dysglycaemia (esp DM pts)
• CDAD (esp cipro)
• aortic dissection / rupture of aortic aneurysm
• QTc prolongation (levo, moxi)
• phototoxicity
• tendinitis / tendon rupture
• headache, dizzy
• peripheral neuropathy

C/I: <18y (cause arthropathy), pregnant, myasthenia gravis

Question 11

Co-trimoxazole

Answer 11

• N/V (take after food, drink with full cup of water)
• photosensitivity
• hypersensitivity (SJS, rash)
• crystalluria -> adequate hydration
• hepatotoxicity
• myelosuppression
• hyperK
• kernicterus (newborns if mothers take at last trimester -> sulpha drugs displace bilirubin on albumin)

C/I: sulpha allergy, G6PD deficiency, 1st & 3rd trimester pregnancy, CrCl <15ml/min

Question 12

Nitrofurantoin

Answer 12

• GI (N/V/D, upset -> take with food)
• headache
• dark-coloured urine
• pulmonary fibrosis (esp elderly)
• peripheral neuropathies with dose-accumulation (renal impairment)
• hepatotoxicity (rare)

C/I: CrCl <30ml/min, pregnancy at term (≥38w), G6PD deficiency

Question 13

Fosfomycin

Answer 13

• headache
• diarrhoea
• vaginitis

C/I: CrCl <30ml/min

Question 14

Metronidazole

Answer 14

• metallic taste in mouth
• GI (N/V, epigastric distress, abdominal cramps)
• oral moniliasis (yeast infx in mouth)
• convulsive seizures, optic & peripheral neuropathy

C/I: alcohol, pregnancy 1st trimester

Question 15

Rifampicin

Answer 15

• orange discolouration of body fluids (tears, sweat, urine)
• flu-like syndrome
• cutaneous syndrome (flushing, pruritic, rash, redness & watering of eyes)
• resp syndrome (SOB)
• hepatotoxicity