Editing Infections: Antibiotics (section)

==Common Adverse Reaction and Contraindications==
{| class="wikitable"
|'''Drug or drug class'''
|'''Common adverse reactions'''
|'''Precautions and contraindications'''
|-
|'''Amoxicillin or ampicillin'''
'''Ampicillin with sulbactam'''
|
*'''Hypersensitivity (immediate or delayed)'''
*'''Diarrhea (especially with ampicillin), GI upset'''
*'''Antimicrobial-associated pseudomembranous colitis'''
*'''Maculopapular rash (not hypersensitivity)'''
*'''Decreased platelet aggregation'''
|
*'''Increased risk of rash with concomitant viral disease, allopurinol therapy'''
|-
|'''Amoxicillin with clavulanic acid'''
|
*'''Increased diarrhea, GI upset'''
|
|-
|'''Anti-staphylococcal penicillins'''
|
*'''Same as with amoxicillin/ampicillin'''
*'''GI upset (with oral agents)'''
*'''Acute interstitial nephritis (especially withmethicillin)'''
|
|-
|'''Anti-pseudomonal penicillins'''
|
*'''Same as with amoxicillin/ampicillin'''
*'''Hypernatremia (these drugs are given as sodium salt; especially carbenicillin, ticarcillin)'''
*'''Local injection site reactions'''
|
*'''Use with caution in patients very sensitive to sodiumloading'''
|-
|'''Cephalosporins'''
|
*'''Hypersensitivity (less than with penicillins)'''
*'''GI upset (with oral agents)'''
*'''Antimicrobial-associated pseudomembranous colitis'''
*'''Local injection site reactions'''
*'''Positive Coombs test'''
*'''Decreased platelet aggregation (especially''' '''with cefotetan, cefamandole, cefoperazone)'''
|
*'''Avoid in patients with immediate hypersensitivity to penicillins; may use with caution in patients with delayed hypersensitivity reactions'''
*'''Ceftriaxone is contraindicated in neonates'''
|-
|Aztreonam
|
*Hypersensitivity (less than with penicillins)
|
*<1% incidence of cross-reactivity in penicillin- or cephalosporin-allergic patients; may be used with caution in these patients
|-
|'''Aminoglycosides'''
'''(gentamicin, tobramycin)'''
|
*'''Ototoxicity: vestibular and auditorycomponents'''
*'''Nephrotoxicity: nonoliguric azotemia'''
*'''Neurotoxicity: neuromuscular blockade with high levels'''
|
*'''Avoid in pregnant patients, except in pyelonephritis.'''
*'''Avoid, if possible, in patients with severely impaired renal function, diabetes, or hepatic failure'''
*'''Use with caution in myasthenia gravis patients (owing to potential for neuromuscular blockade)'''
*'''Use with caution with other potentially ototoxic andnephrotoxic drugs.'''
|-
|'''Fluoroquinolones'''
|
*'''<span style="color:#ff0000">Tendon rupture</span>''' (incidence 20 cases/100,000), should be discontinued at the first sign of tendon pain
*'''<span style="color:#ff0000">Aortic rupture</span>''' (incidence 20 cases/100,000), should be discontinued at the first sign of tendon pain
*'''<span style="color:#ff0000">QT interval prolongation;'''should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia or hypomagnesemia, and patients receiving some antiarrhythmic agents
*'''Photosensitivity'''
*'''Mild GI effects'''
*'''Central nervous system effects, including''' '''dizziness, tremors, confusion, mood disorder, hallucinations, light-headedness'''
*'''Hypoglycemia and hyperglycemia''' have been reported in patients treated concurrently with fluoroquinolones and anti-diabetic agents; '''avoid or monitor glucose levels closely in patients on anti-diabetic drugs'''
|
*'''Avoid in children or pregnant patients due to arthropathic effects.'''
*'''Concomitant antacid, iron, zinc, or sucralfate usedramatically decreases oral absorption'''; use another antimicrobial agent or discontinue sucralfate use while on quinolones. Space administration of quinolones from antacids, iron, or zinc products by at least 2 hr to ensure adequate absorption.
*'''Can significantly increase theophylline plasma levels; avoid quinolones or monitor theophylline levels closely.'''
*'''Can lower seizure threshold'''; avoid in patients with epilepsy and in patients with other risk factors (medications or illness) that may lower the seizure threshold.
*'''Avoid in patients receiving warfarin; can enhance warfarin effects'''; closely monitor coagulation tests.
*'''Avoid with other drugs that prolong QT interval, such as amiodarone'''
|-
|'''Fosfomycin'''
|
*'''Headache'''
*'''GI upset'''
*'''Vaginitis'''
|
|-
|Pivmecillinam
|
*Rash GI upset
|
*Use with caution in patients with penicillin hypersensitivity
|-
|'''Nitrofurantoin'''
|
*'''<span style="color:#ff0000">Pulmonary</span> hypersensitivity reactions can range from acute to chronic and include cough, dyspnea, fever, and interstitial changes [e.g. fibrosis].'''
*'''<span style="color:#ff0000">Hepatoxicity'''
*'''<span style="color:#ff0000">Peripheral neuropathy''' (especially in patients with impaired renal function, anemia, diabetes, electrolyte imbalance, vitamin B deficiency, and debilitated)
*'''<span style="color:#ff0000">GI upset'''
*'''<span style="color:#ff0000">Hemolysis in patients with G6PD deficiency'''
|
*'''Avoid in patients with decreased renal function(<50 mL/min) because adequate urine concentrations will not be achieved.'''
*'''Avoid concomitant probenecid use, which blocks renal excretion of nitrofurantoin.'''
*'''Monitor long-term patients closely.'''
*'''Avoid concomitant magnesium or quinolones, which are antagonistic to nitrofurantoin'''
*'''Can be given safely to patients receiving warfarin'''
*'''See below regarding use in pregnancy'''
|-
|'''Trimethoprim-sulfamethoxazole'''
|
*'''Hypersensitivity, rash'''
*'''GI upset'''
*'''Photosensitivity'''
*'''Hematologic toxicity (AIDS patients)'''
|
*'''Higher incidence of all adverse reactions occurs in AIDS patients and the elderly.'''
*'''Avoid TMP-SMX in pregnancy because of early potential for teratogenicity and late potential for kernicterus'''
*'''Avoid TMP-SMX in neonates due to risk of kernicterus from hyperbilirubinemia'''
*'''Trimethoprim alone should be avoided in pregnancy due to risk of megaloblastic anemia'''
*'''Trimethoprim alone can be used in neonates'''
*'''Avoid in patients receiving warfarin; can enhance warfarin effects'''; closely monitor coagulation tests.
*'''Avoid with other anti-arrhythmics, such as amiodarone'''
|-
|'''Vancomycin'''
|
*'''“Red-man syndrome”: flushing, fever, chills,''' '''rash, hypotension (histaminic effect)'''
*'''Nephrotoxicity and/or ototoxicity when combined with other nephrotoxic and/or ototoxic drugs'''
*'''Local injection site reactions'''
|
*'''Use with caution with other potentially ototoxic andnephrotoxic drugs.'''
|}