Classic summary of adverse reactions of ten major categories of antibacterial drugs!

*For medical professionals only

Focus on clinical rational use!

Penicillins: penicillin, amoxicillin, etc.
1, allergic reactions: anaphylactic shock (type I allergy) and serum type sickness reaction (type III allergy)
can occur.

Other allergic reactions include hemolytic anemia (type II allergic reaction), drug rash, contact dermatitis, interstitial nephritis, asthma attacks, etc
.
The Chinese Pharmacopoeia stipulates that patients need to do penicillin skin tests
before using penicillin antibiotics.

Therefore, whether adults or children, regardless of the different routes of administration such as oral, intravenous or intramuscular, a skin test
should be performed before the use of penicillins.

After stopping the drug for more than 72 days, the skin test should be re-examined
.
2.
Herthrent reaction: The induced reason for the Hersch reaction is that the killing effect of the drug on treponema pallidum is too strong, resulting in a large number of deaths of treponemal syphilis, a large number of harmful substances overflow from the dead syphilis helix and the abnormal reaction inside the body causes the body to have an uncomfortable reaction
.
3.
Toxic reaction: peripheral neuritis
can occur in the intramuscular injection area of penicillin.

Intrathecal injection of more than 20,000 or intravenous infusion of large doses of this product can cause penicillin encephalopathy (muscle clonus, convulsions, coma and other reactions).

4.
Secondary infection: penicillin-resistant Staphylococcus aureus, gram-negative bacillus or Candida albicans infections may occur during treatment, and candida overproduction can make the tongue moss brown or even black
.

All antimicrobials can cause a double infection
.

Dicephalosporins: cefotaxin, cefdinib, etc.
1, allergic reactions: the instructions clearly require the skin test of cephalosporins: ceftiam, cefomeme, ceftiazole sodium, cefotaxime sodium sulbactam sodium, cefotaphene sodium and so on
.
2.
Coagulation dysfunction: all cephalosporins can inhibit the production of vitamin K by the intestinal flora, so there are potential adverse reactions that lead to bleeding, and some cephalosporins can still interfere with vitamin K circulation in the body, hinder the synthesis of prothrombin, disrupt the coagulation mechanism, and lead to a more obvious bleeding tendency
.
3.
Disullen-like reaction: after using cephalosporin containing methothiolazole side chain for several days, if you drink alcoholic beverages, sometimes there will be flushing, nausea, vomiting, sweating, tachycardia, rapid breathing, and occasional clinical manifestations of hypotension and confusion, which is the so-called "disulfiram-like reaction"
.
Cefoperazone, ceftriaxone, cefzolin, cefradin, laxacycephalosporin, etc.
in cephalosporins can lead to disulfiram-like reactions, of which cefoperazone is the most reported, while cefotaxime, ceftazidime and other methiotetrazole side chains, so such cephalosporins do not lead to disulfiram-like reactions
.
4.
Cephalosporin antibiotic encephalopathy: a kind of central nervous system toxicity reaction of cephalosporin antibiotics, in patients with chronic renal insufficiency, the dosage is too large, the intravenous instillation speed is too fast, the course of treatment is too long, the drug quickly enters the brain tissue, that is, the concentration of the drug in the cerebrospinal fluid rises rapidly, interfering with normal nerve cell function, causing serious central nervous system symptoms, such as euphoria, hallucinations, perceptustic impairment, hyperreflexia, and even convulsions, lethargy, Coma and a range of other neurological symptoms
.

Triquinolones: ofloxacin, moxifloxacin, etc.
1, exacerbation of myasthenia gravis: all fluoroquinolone drugs have neuromuscular blocking activity and may exacerbate myasthenia symptoms
in patients with myasthenia gravis.

The use of fluoroquinolones in patients with myasthenia gravis may result in death or require assisted breathing, and patients with myasthenia gravis should use such drugs
with caution.
2.
Peripheral neuropathy: if the patient has symptoms of peripheral neuropathy, such as pain, burning, tingling, numbness, and/ or weakness or other sensory changes such as light touch, pain, temperature, position and vibration, fluoroquinolone
should be discontinued.
3.
Affect the blood glucose control level of diabetic patients: Lomefloxacin, moxifloxacin, ofloxacin and other fluoroquinolone drugs may affect the blood glucose control level of diabetic patients, of which moxifloxacin has the highest
risk.
4.
Nerve/mental system damage: because the molecular structure contains fluoride, fluoroquinolone has a certain fat solubility, which can enter the brain tissue through the blood-brain barrier, block the inhibiting neurotransmitter γ-aminobutyric acid (GABA) to bind to the receptor, and produce central nervous system excitement
.

It is mainly manifested as headache, dizziness, tremor, convulsions, extravertebral extracorporeal reactions, hallucinations, etc.
, and in severe cases, there are epileptic seizures, schizophrenoid reactions, and impaired consciousness
.
5.
Photosensitivity reaction: it is mainly manifested as redness and swelling of the hands, face and other skin exposed to light, accompanied by itching or burning sensation, and in severe cases, skin shedding
occurs.

Photosensitivity reactions are fluoroquinolone-like reactions related to
the chemical structure of fluoroquinolones.

Therefore, when using fluoroquinolones, exposure to sunlight and ultraviolet light should be avoided, and sunscreen and blackout clothing should be used for prevention
.

Four major cyclolides: erythromycin, azithromycin, etc.
1, cardiotoxicity: the cardiotoxicity of macrolide antibiotics is mainly manifested as QT interval prolongation and torsades de pointes ventricular tachycardia, which is dangerous, clinically patients can appear coma and sudden death, induced by erythromycin
.
In order to reduce or avoid the occurrence of cardiotoxicity, clinicians need to understand the possibility of inducing cardiotoxicity before applying this class of drugs, carefully select drugs according to the patient's condition and the situation of the drug used, pay attention to observation during medication, and monitor the electrocardiogram
if necessary.
2.
Hepatotoxicity: at commonly used doses, hepatotoxicity is small
.

Hepatotoxic reactions, mainly manifested as cholestasis, abnormal liver function, etc.
, can generally be restored
after stopping the drug.

For example, azithromycin can cause changes in liver function, elevating ALT and AST, and roxithromycin can also lead to jaundice and abnormal
liver function in a short course of treatment.
Attached: inhibition of theophylline metabolism: This class of drugs can inhibit the normal metabolism of theophylline (except for azithromycin), so it is not appropriate to combine with aminophylline drugs to prevent abnormal increase in the concentration of theophylline and cause poisoning, or even death
.

When it must be used, the theophylline concentration should be monitored in the hospital to prevent accidents
.

Pentacycline: minocycline, doxycycline, etc.
1, affect the development of teeth and bones: mainly on the fetus and infants and young children, tetracycline antibiotics can be deposited in the bones and teeth of embryos and young children, and combined with calcium, which can cause tooth enamel yellowing (commonly known as tetracycline teeth) and hypoplasia
.

Pregnant women, lactating women and children under 8 years of age are contraindicated
.
2.
Gastrointestinal reactions: such as nausea, vomiting, epigastric discomfort, bloating, diarrhea, etc.
, which can occasionally cause reports of pancreatitis, esophagitis and esophageal ulcers, and mostly occur in patients who
are bedridden immediately after taking the drug.
3.
Central nervous system: occasionally it can cause benign intracranial pressure to increase, which can be manifested as headache, vomiting, optic nerve papilledema, etc
.

Hexaaminoglycosides: gentamicin, amikacin et al.
1, ototoxicity: including vestibular dysfunction and cochlear auditory nerve damage
.

Vestibular dysfunction manifests as dizziness, vision loss, nystagmus, vertigo, nausea, vomiting, and ataxia; Cochlear auditory nerve injury manifests as tinnitus, hearing loss, and permanent deafness
.

Clinically, it should be avoided in combination with highly effective diuretics or other ototoxic drugs such as cisplatin
.
2.
Nephrotoxicity: aminoglycoside antibiotics are mainly excreted by the kidneys in their original form, and can accumulate a large amount of drugs in the renal cortex through cell membrane swallowing, so they can cause nephrotoxicity
.

Mild causesTubular swelling, severe cases of acute tubular necrosis, but generally do not damage the glomeruli
.

Nephrotoxicity usually manifests as proteinuria, casturia, hematuria, etc.
, and in severe cases, azotemia and decreased
renal function.
3.
Neuromuscular blockade: most commonly seen after high-dose intraperitoneal or intrapleural application, and occasionally after
intramuscular or intravenous injection.

The reason for this may be that the drug is complexed with Ca2+, reducing the content of Ca2+ in the body fluids, or competing with Ca2+, inhibiting the release of nerve endings Ach, and reducing the sensitivity of the postsynaptic membrane to Ach, causing the transmission of neuromuscular joints to block, causing respiratory muscle paralysis, which can lead to respiratory arrest
.

Heptanidimidazole: metronidazole, tinidazole, etc.
1, neurotoxicity: nitroimidazole drugs can pass through the blood-brain barrier, have neurotoxic effects, and there may be adverse neurological reactions when using drugs, such as headaches, dizziness, etc.
, such as prolonged treatment, it is easy to cause neurotoxicity and cause mental abnormalities
.
2.
Disulfiram-like reaction: it can inhibit ethanol metabolism, cause ethanol accumulation in the body, and interfere with the oxidation process
of ethanol.

Disulfiram-like reactions (facial flushing, headache, dizziness, abdominal pain, stomach pain, nausea, vomiting, shortness of breath, increased heart rate, decreased blood pressure, drowsiness, hallucinations, etc.
)
may occur when combined.

Exposure to alcoholic beverages
should be avoided during treatment and for 7 days after discontinuation.
3.
Gastrointestinal reactions: such as nausea, loss of appetite, vomiting, diarrhea, abdominal discomfort, abdominal cramps, taste changes, dry mouth, oral metal taste, etc.
, generally do not affect the treatment
.

Octasulfonamides: compound neodazole, etc.
1, cross-allergy: patients who are allergic to one sulfonamide may be allergic
to other sulfonamides.

Patients who are allergic to furosemide, sulfone, thiazide diuretics, sulfonylureas, and carbonic anhydrase inhibitors may also be allergic
.
2.
Crystallization: if crystallituria or hematuria is found in the treatment, sodium bicarbonate and drinking a lot of water can be given until crystallituria and hematuria disappear
.

The application course is long, and when the dose is large, it is advisable to take sodium bicarbonate and drink more water, and cannot be combined
with vitamin C.

Hexachloramphenicol: chloramphenicol, thiamycin, etc.
1, dose-independent bone marrow toxicity: severe, irreversible re-disorder, high case fatality rate, a small number of survivors can develop myelogenous leukemia
.

Patients with re-disabilities can have an incubation period of several weeks to several months, which is not easy to detect early, and its clinical manifestations include bleeding tendencies caused by thrombocytopenia, complicated by petechiae, ecchymosis and epistaxis
.
When chloramphenicol is used topically, if the course of treatment is long and repeated, it can also have a certain degree of absorption, and occasionally a hematologic toxic reaction
can occur.
2.
Gray infant syndrome: clinical manifestations are bloating, vomiting, progressive pallor, cyanosis, microcirculation disorders, body temperature does not rise, and breathing irregularities
.

Usually occurs in preterm or neonatal infants with
high-dose chloramphenicol.
3.
Hepatotoxicity: the application of chloramphenicol in patients with original liver disease may
cause jaundice, hepatic fat infiltration, and even acute hepatic necrosis.
4.
Neurotoxicity: after long-term medication, peripheral neuritis and optic neuritis, hearing loss, insomnia, vision hallucinations, delirium and other symptoms can occur, most of which are reversible
.

There have also been reports
of optic nerve atrophy and blinding after long-term medication.

Decalin: lincomycin, clindamycin, etc.
1, can cause pseudomembranous enteritis: the incidence is high, may exceed 2%.


If pseudomembylitis enteritis occurs, vancomycin is used to take oral 0.
125 to 0.
5 g and treat
it 4 times a day.
2.
It has neuromuscular blocking effect, which can cause respiratory depression and may improve the effect of
other neuromuscular blockers.

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