#EMconf: Antibiotic Side Effects
Thu, 05/25/2017 - 6:33am
Side Effects of Common Antibiotics
Sulfonamides:
- Erythema Multiforme that ranges from EM Minor to Stevens-Johnson Syndrome to Toxic Epidermal Necrolysis
- Treatment: stop offending agent, supportive care, possible admission to burn unit
Fluoroquinolones:
- Tendonitis and tendon rupture (Achilles) especially for age >60, corticosteroids, renal insuffieiency, previous tendon injury
- Avoid in benzodiazepine dependent patients; can cause acute withdrawal by displacing the benzo from its binding site
Aminoglycosides:
- Ototoxicity: Cochlear damage by free oxygen radicals causes permanent impairment (Macrolides: temporary impairment)
- Nephrotoxicity: ATN and non-oliguric renal failure (reversible), more risk with frequent or very high doses, duration >3 days, and older age
Clindamycin:
- Liver injury: 1-2x increase in AST/ALT with return to baseline within 2 weeks after cessation of antibiotic and Acute Idiosyncratic Liver Injury: 2-12x increase in AST/ALT over baseline with fever and jaundice. NOT associated with liver failure
- Most common antibiotic to cause C. Difficile colitis
Linezolid:
- Serotonin Syndrome: can occur when combined with another serotonergic drug (SSRI, MAOI, TCAs)
References: 1. Tintinalli, Judith E., MD. "Antimicrobials." Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, 2015. 1346-350. Print. 2. Holubar, Marisa, MD. "Antibiotic Stewardship." UpToDate, 1 May 2014. Web. 5 May 2017.