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

Adverse ReactionsAdverse 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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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 eitherdose-related (toxic) or unpredictable. Unpredictable reactions are eitheridiosyncratic or allergic. Dose-related reactions include aminoglycoside-inducednephrotoxicity, linezolid-induced thrombocytopenia, penicillin-induced seizures,and vancomycin-induced anaphylactoid reactions. Many of these reactions can beavoided by reducing dosage in patients with impaired renal function, limiting theduration of therapy, or reducing the rate of administration. Adverse reactions toantibacterial agents are a common cause of morbidity, requiring alteration intherapy and additional expense, and they occasionally result in death. The elderly,often those with the more severe infections, may be especially prone to certainadverse reactions. The most clinically relevant adverse reactions to commonantibacterial drugs are listed in Table 127-7. For further discussion of adverse drugreactions, see Chap. 5. Table 127-7 Most Clinically Relevant Adverse Reactions to CommonAntibacterial 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, neutropeniaAminoglycosides 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 toxicitiesMacrolides/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 ...