Unusual effects of common antibiotics

Abstract

A 60-year-old man is admitted for respiratory failure following a massive myocardial infarction. He develops ventilator-associated pneumonia and is treated with cefepime and vancomycin. Three days later, he develops prolonged atypical absence seizures. What caused these seizures? The neurologist thinks it might be the cefepime. Do you agree? Antibiotics are widely used in the United States, with 269 million courses of oral therapy prescribed in 2011. 1 Adverse effects such as rash are well known, but rare effects such as seizure, hypoglycemia, and hypoxemia may not be immediately attributed to these drugs. In this article, we review less-recognized but potentially serious adverse effects of antibiotics commonly prescribed in the United States. We have structured our discussion by organ system for ease of reference. ■ NERVOUS SYSTEM The potential adverse effects of antibiotics on the nervous system range from encephalopathy and seizure to nonconvulsive status epilepticus. Encephalopathy and seizure Encephalopathy has been reported with penicillins, cephalosporins, sulfamethoxazole-trimethoprim, quinolones, and oxazolidinones such as linezolid. 2,3 Seizures are known to occur with penicillins, cephalosporins, carbapenems, and quinolones. 2-4 For cephalosporins, these effects are more common at higher doses, in elderly patients, and in patients with renal impairment. Carbapenems are associated with seizure activity in elderly patients. 2-4

Antibiotics and the Nervous System—Which Face of Antibiotic Therapy Is Real, Dr. Jekyll (Neurotoxicity) or Mr. Hyde (Neuroprotection)?

“…Similarly, fluoroquinolone use was found to be associated with seizures and headaches in 1-2% of recipients. The other, unusual effects observed in patients treated with fluoroquinolones (ofloxacin, sparfloxacin) included orofacial dyskinesia and a Tourette-like syndrome [18]. Neuromuscular blockade and the possibility of intensification of the action of intraoperative muscle relaxants is the most commonly known neurological ADR of aminoglycosides, but the symptoms were also demonstrated for tetracyclines, polymyxins, lincomycin, clindamycin, although to a much lesser extent.…”

Broad-Spectrum Antibiotics for Breast Expander/Implant Infection

“…Weekly monitoring of liver and kidney function tests are recommended because almost all antimicrobials, however infrequent it may be, have been associated with potential injury to liver and kidneys. 23,27 Also, treatment-specific laboratory tests, such as weekly CPK, will be needed if the patient is on daptomycin. There is a myriad of antibiotic-related adverse events reported in the literature.…”

“…The treating physician should be knowledgeable about signs of potential adverse events so that patient's care is accordingly modified. Weekly monitoring of liver and kidney function tests are recommended because almost all antimicrobials, however infrequent it may be, have been associated with potential injury to liver and kidneys 23,27 . Also, treatment-specific laboratory tests, such as weekly CPK, will be needed if the patient is on daptomycin.…”