Going From A To Z With Antibiotic Toxicities

This put up is ready antibiotic toxicities from A to Z!

Authored via: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP

Posted 9 June 2022

This text identifies an antibiotic toxicity for each letter within the alphabet. It does now not record each antibiotic aspect impact. It’s supposed to focus on that antibiotic use does now not come with out possibility. Use antibiotics with warning and handiest when indicated. Don’t proportion antibiotics. Simplest use antibiotics below the route of a certified scientific skilled.

Be the primary to make use of an antibiotic and also you possibility toxicity. Be the ultimate to make use of an antibiotic and also you possibility efficacy.


A is for arrhythmia

A large number of antibiotics can elicit an arrhythmia. Azithromycin is one such drug. [1]

B is for bronchospasm

Inhaled antibiotics could cause bronchospasm. For instance, inhaled tobramycin. [2]

C is for C difficile related diarrhea (CDAD)

Virtually all antibiotics can CDAD. One of the most maximum not unusual medication to purpose it are fluoroquinolone like ciprofloxacin and levofloxacin. [3]

D is for dysgeusia

Relatively a couple of antibiotics could cause altered style sensation (aka dysgeusia). Metronidazole is one instance of this, not unusual to purpose a nasty metal style. [4]

E is for eosinophilic pneumonia and electrolyte abnormalities 

Daptomycin as an example, has been identified to purpose eosinophilic pneumonia. [5]

Many antibiotics could cause or give a contribution to electrolyte abnormalities. Sulfamethoxazole-trimethoprim (particularly at top doses) could cause important problems with hyperkalemia, as an example. [5.5]

F is for foamy urine

I’ve at all times discovered it fascinating that telavancin could cause foamy urine. [6]

G is for glycemic adjustments

Fluoroquinolone could cause hypoglycemia and hyperglycemia. [7]

H is for allergic reaction response

Virtually all antibiotics could cause allergic reaction reactions. Do you know that about 10% of sufferers in the USA record a penicillin hypersensitivity, however not up to 1% of individuals are in truth penicillin allergic!?! [8]

I is for infusion reactions

A number of antibiotics could cause infusion-related reactions. One instance is vancomycin infusion response (previously known as “purple guy” or “purple neck” syndrome) which occurs when vancomycin is infused too speedy inflicting histamine liberate. [9]

J is for Joint Ache

Utilization of sulphonamides and trimethoprim, is related to a 70% greater possibility of RA flare at 1–3 months, which is able to purpose important joint ache. [10]

Ok is for kernicterus

Ceftriaxone would possibly purpose kernicterus in neonates. [11]

L is for liver enzyme elevation 

Penicillinase-resistant penicillin oxacillin is also a go-to IV antibiotic for some MSSA infections, however it’s additionally infamous for inflicting liver enzyme elevation. I discovered an article from 1973 that talks about it. We’ve been coping with oxacillin liver problems for over 50 years! [12] A large number of different antibiotics can do that as neatly. Trovafloxacin (a fluoroquinolone antibiotic) used to be even got rid of from the marketplace for inflicting liver harm! [13]

M is for psychological well being unintended effects

Psychological well being aspect results of fluoroquinolones come with disturbances in consideration, disorientation, agitation, anxiety, reminiscence impairment, and severe disturbances in psychological talents known as delirium. [14] The label on systemic fluoroquinolones additionally comprises suicide as a caution as a part of the prospective central worried results. [15]

N is for nephrotoxicity and neurotoxicity

Many antibiotics could cause nephrotoxicity, together with as vancomycin and the aminoglycosides. Beta-lactams can too, methicillin used to be even got rid of from the marketplace because of inflicting interstitial nephritis. [16]

Cefepime is an instance of an antibiotic that may purpose neurotoxicity. [17]

O is for optic neuropathy and ototoxicity

Linezolid could cause optic neuropathy that may be irreversible and is much more likely to occur with longer intervals of remedy. [18]

Aminoglycosides are identified to purpose ototoxicity and will moreover purpose steadiness issues. [19]

P is for pulmonary fibrosis and pancreatitis

Nitrofurantoin could cause pulmonary fibrosis, which is much more likely to occur with extended or repeated use. [20]

Tigecycline has been discovered to purpose acute pancreatitis. [21]

Q is for QTc prolongation

Fluoroquinolone and macrolides can each purpose QTc prolongation. [22,23]

R is for rhabdomyolysis

Daptomycin could cause CPK elevation and rhabdomyolysis. [24]

S is for Steven Johnsons Syndrome (SJS) and seizures

SJS is a horribly unlucky illness wherein to position it merely, pores and skin peels off the frame. Many antibiotics had been flagged for inflicting SJS, together with sulfonamides, aminopenicllins (maximum not unusual antibiotic purpose), fluoroquinolones, tetracyclines, macrocodes, cephalosporins, and metronidazole. [25]

Carbapenems had been implicated in inflicting seizures. [26]

T is for tendon rupture, thrombocytopenia, and poisonous epidermal necrolysis (TEN)

Fluoroquinolones have a FDA boxed caution for tendon rupture. [27]

Linezolid and tedizolid are two antibiotics that may purpose thrombocytopenia. [28]

TEN is a worse type of SJS and plenty of antibiotics could cause it. [29]

U is for uveitis-associated systemic sicknesses

Fluoroquinolone antibiotics had been related to uveitis-associated systemic sicknesses. [30]

V is for vomiting

Nearly all antibiotics could cause vomiting and nausea, however tigecycline merits explicit notice because it brought about nausea and vomiting in 30% of older male sufferers in segment 3 scientific trials. [31] Tolerability is a big factor for tigecycline.

W is for weak spot

Aminoglycoside antibiotics, when given to sufferers with neurological stipulations similar to myasthenia gravis or Lambert Eaton myasthenic syndrome, can aggravate neuromuscular weak spot. [32]

X is for xerostomia

Xerostomia is often referred to as dry mouth. Whilst now not not unusual, fluoroquinolones had been identified to purpose it. [33,34]

Y is for yellowing of the eyes

A number of antibiotics had been been discovered to purpose jaundice (yellowing of the whites of the eyes or the outside), together with amoxicillin-clavulanic acid. [35]

Z is for zygote toxicity

A zygotę is every other title for a fertilized egg. There are a selection of antibiotics that may purpose fetal hurt, together with fluoroquinolones and tetracyclines [36] Sure it used to be tricky to discover a toxicity for the letter z!

Did you understand fluoroquinolones have been discussed 11 occasions!

Final feedback

With all of those doable antibiotic toxicities (and plenty of extra now not indexed right here), it indubitably must give us all pause to in point of fact believe whether or not antibiotics are indicated and definitely worth the possibility, prior to taking/ prescribing/ proceeding them.

Certainly antibiotics are a miracle of contemporary drugs and will save lives when given to the correct sufferers. On the other hand, their advantages will have to be balanced towards their dangers and the specter of antibiotic resistance.


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Disclaimer: The critiques and views offered on this article are that of the creator and don’t essentially constitute the location or coverage of any former, present, or doable long run employer.


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