Antimicrobial Safety and Tolerability: Differences and Dilemmas

Abstract

The adverse drug reactions associated with antimicrobials have become a topic of major importance and concern in the last few years. Antimicrobial toxicity may take many forms, varying from mild, transient phenomena to dramatic, life-threatening events such as seizures or cardiac arrhythmias. We review the toxicity of antimicrobials in general and of the fluoroquinolones in particular and attempt to explain the adverse events by use of structure-adverse event relationships where possible. There are currently 5 main mechanisms that can be invoked to explain antimicrobial toxicity: direct effects, hypersensitivity, changes in microbial flora, drug interactions, and microbial lysis. The adverse drug reactions seen with fluoroquinolones are explained on the basis of these 5 mechanisms. The various organ systems affected by the fluoroquinolones are considered; then individual members of the fluoroquinolone class are reviewed. The unexpected and dramatic problems encountered with temafloxacin and trovafloxacin are discussed as well.

In Vitro Activities of Moxifloxacin against 900 Aerobic and Anaerobic Surgical Isolates from Patients with Intra-Abdominal and Diabetic Foot Infections

“…Newer quinolones have improved in vitro activity against anaerobes, with trovafloxacin, moxifloxacin, and gatifloxacin having more potent activities than levofloxacin and ciprofloxacin (1, 3). Unfortunately, safety and toxicity concerns have limited the potential therapeutic usefulness of many of these agents (11,14,15,21). The present study was undertaken to investigate the in vitro activity of moxifloxacin against aerobic and anaerobic clinical isolates recently obtained from surgical patients with diabetic foot and intra-abdominal infections.…”

Ciprofloxacin-Induced Urticaria and Tenosynovitis: A Case Report

“…The overall rate of dermatological adverse events, such as maculopapular or urticarial eruptions, and phototoxic reactions following fluoroquinolone use is 0.5-3% [1,3,6] . The presented patient developed urticarias.…”

“…The rate of skin reactions including rash, urticaria and exfoliative dermatitis is 0.7%. [1][2][3][4] . Incidence of tendinitis and tendon rupture is rare [1,4,5] .…”

In vitro Antibacterial Activity and Cytotoxicity of Lagerstroemia speciosa Bark Extract

“…The time-kill curves study provides more accurate description on the pharmacodynamics of antimicrobial agents than the MIC [2,3] . The accumulation of antimicrobial drugs and their metabolic byproducts due to repetitive administration can cause unwanted side-effects to tissues and organs [4] . Therefore, in most antimicrobial studies, the toxicity test is needed to provide an indication of possible toxicity level of the antimicrobial agent towards the normal intestinal flora and other organs of the infected host.…”

“…Therefore, in most antimicrobial studies, the toxicity test is needed to provide an indication of possible toxicity level of the antimicrobial agent towards the normal intestinal flora and other organs of the infected host. The mechanisms of antimicrobial toxicity are including direct effects, hypersensitivity, changes in microbial flora, drug interactions and microbial lysis [4] . The toxicity study of new antimicrobial agents is usually performed via the brine shrimp toxicity test [5] .…”