1. SIDE EFFECTS AND TOXICITY

2. GI EFFECTS • Almost all antibiotics are irritating to the GI tract. • Diarrhea is very common. • Nausea, vomiting.

3. TETRACYCLINES-GI EFFECTS • Common upon oral administration. • Epigastric burning and distress, abdominal discomfort, nausea and vomiting and diarrhea.

4. ADVERSE EFFECTS • Nausea and vomiting usually subside as medication continues. • If troublesome GI irritation can be controlled with food. • Important to distinguish irritative diarrhea from superinfection.

5. CLINDAMYCIN • Diarrhea fairly common

6. HYPERSENSITIVITY REACTIONS • Most antibiotics produce hypersensitivity reactions. • β-lactams. • Sulfonamides and its combinations.

7. PENICILLINS • Cross allergenicity among all the penicillins (and other beta lactams). • Results from a previous treatment.

9. HYPERSENSITIVITY REACTIONS • Occurs with almost any dosage form of penicillin. Oral penicillins have a lower risk than parenterals. • Usually clear with elimination of the penicillin.

10. HYPERSENSITIVITY REACTIONS • Skin rashes. • Fever. • Bronchospasm. • Vasculitis, serum sickness, exfoliative dermatitis, contact sensitivity, local swelling and redness,oral lesions, eosinophilia. • ANGIOEDEMA AND ANAPHYLAXIS.

14. ANAPHYLAXIS • Most important immediate danger. • Incidence is low (0.04 -0.2%). • Sudden, severe hypotension and rapid death.

15. ANAPHYLAXIS • Careful observation of the patient is important.

16. ANAPHYLAXIS-TREATMENT • Epinephrine (IV or IM) • IV steroids • Supportive measures

17. MGMT. OF THE PATIENT POTENTIALLY ALLERGIC • Evaluation and history.

18. www.bris.ac.uk/ Depts/ ENT

19. DESENSITIZATION.

20. CEPHALOSPORINS • Rashes occur frequently. • Cross-sensitivity to penicillins.

21. HYPERSENSITIVITY REACTIONS • Patients with a history of a mild or temporally distant reactionto penicillin appear to be at low risk.

22. Sulfonamides • Skin rashes are common.

24. STEVENS JOHNSON SYNDROME • Uncommon but most likely to occur following sulfonamide therapy

25. PHOTOSENSITIVITY • Sulfonamides • Tetracyclines • Fluoroquinolones

31. HEMATOLOGICAL TOXICITY • Sulfonamides (with trimethoprim) • Chloramphenicol • Ticarcillin and Piperacillin • Linezolid

32. Trimethoprim-Sulfamethoxazole

34. TRIMETHOPRIM DNA FOLINICACID DIHYDROPTEROIC ACID Dihydropteroate Synthetase DHF Dihydrofolate Reductase THF

35. CHLORAMPHENICOL • HEMATOLOGICAL TOXICITY-2 TYPES

36. IDIOSYNCRATIC APLASTIC ANEMIA • Leukopenia, thrombocytopenia, and aplasia of the marrow. • Not dose-related. • Can be fatal.

37. DOSE-DEPENDENT ANEMIA • Reversible dose-related suppression of bone marrow. • Usually presents as anemia, reticulocytopenia and increased serum iron. • Associated with high doses and/or prolonged treatment. • Results from inhibition of mitochondrial protein synthesis.

38. TICARCILLIN AND PIPERACILLIN • Prolong bleeding time (by altering platelet function).

39. LINEZOLID` • Myelosuppression (anemia, thrombocytopenia, leukopenia)

40. HEPATOTOXICITY • Erythromycin estolate (cholestatic hepatitis) • Tetracyclines

41. CHOLESTATIC HEPATITIS • It is caused primarily by the estolate. • Not dose-related. • It is probably a hypersensitivity reaction (to estolate ester).

42. TETRACYCLINES • Dose-related hepatotoxicity (pregnancy).

43. NEUROLOGICAL EFFECTS • Imipenem (seizures) • Aminoglycosides • Fluoroquinolones • Metronidazole

44. AMINOGLYCOSIDES

45. NEUROMUSCULAR BLOCKADE • Rare but potentially serious. • Occurs at high concentrations of aminoglycosides or in patients with an underlying risk factor. • Acute neuromuscular blockade, respiratory paralysis and death can occur.

46. Amino Glycosides

47. FLUOROQUINOLONES • CNS effects such as headache, restlessness, and dizziness. High doses may produce convulsions.

48. METRONIDAZOLE • Headache, dizziness, peripheral neuropathy.

49. CARDIOVASCULAR EFFECTS • Fluoroquinolones • Erythromycin • Chloramphenicol

50. FLUOROQUINOLONES • Some 3rd and 4th generation FQ’s can prolong the QT interval.