Major Antibiotic Toxicities

Penicillin

Hypersensitivity
Hemolytic anemia

Penicillinase-resistant PCNs (methicillin, nafcillin, dicloxacillin)

Hypersensitivity
Acute interstitial nephritis

Ampicillin, amox

Hypersensitivity rxns
Ampicillin rash
Pseudomembranous colitis

Ticarcillin, carbenicillin, pipericillin

Hypersensitivity

Cephalosporins

Cross-hypersensitivity with PCNs
Increased nephrotox. with aminoglycosides
Disulfiram-like rxn with EtOH

Aztreonam

Not much, maybe GI
No cross-reactivity with PCN/ceph

Imipenem/cilastatin, meropenem

GI, rash
CNS toxicity/seizures at high levels

Vancomycin

Nephrotoxicity
Ototoxicity
Thrombophlebitis
"Red man syndrome"
well tolerated in general

Aminoglycosides

Nephrotoxicity (esp with cephalos)
Ototoxicity
Teratogen

Tetracyclines

Discoloration of teeth
Inhibition of bone growth in kids
Photosensitivity
Teratogenic!
*Don't take with milk, antacids*

Macrolides

GI discomfort
Acute cholestatic hepatitis

Chloramphenicol

Anemia
Aplastic anemia
Grey baby syndrome

Clindamycin

Pseudomembranous colitis
Fever
Diarrhea

Sulfonamides

Hypersensitivity/SJ rash
Hemolysis of G6PD def
Nephrotoxicity (tubulointerstitial nephritis)
Photosensitivity
Kernicterus in babies
Displaces other drugs from albumin

Trimethoprim (TMP)

"Treats marrow poorly"
Megaloblastic anemia
Leukopenia
Granulocytopenia
*may alleviate with folinic acid

Fluoroquinolones

Superinfections
Skin rashes
Headache, diziness
Damages cartilage (don't give to pregnant women)
Tendonitis and tendon rupture in adults, leg cramps and myalgias in kids

Metronidazole

Disulfiram-like rxn with EtOH
Headache, metallic taste

Polymyxins

Neurotoxicity
Acute renal tubular necrosis

Ethambutol

Optic neuropathy, retrobulbar neuritis
Red-green color blindness

Anti-TB drugs in general

hepatotoxicity

Isoniazid

Neurotoxicity (B6 can prevent)
Hepatotoxicity
Hemolysis if G6PD deficient
SLE-like syndrome
INH "Injures neurons and hepatocytes"

Rifampin

Minor hepatotoxicity
Orange body fluids
Induces P450