TAILIEUCHUNG - Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 11)

Adverse Reactions Adverse drug reactions are frequently classified by mechanism as either dose-related ("toxic") or unpredictable. Unpredictable reactions are either idiosyncratic or allergic. Dose-related reactions include aminoglycoside-induced nephrotoxicity, linezolid-induced thrombocytopenia, penicillin-induced seizures, and vancomycin-induced anaphylactoid reactions. Many of these reactions can be avoided by reducing dosage in patients with impaired renal function, limiting the duration of therapy, or reducing the rate of administration. Adverse reactions to antibacterial agents are a common cause of morbidity, requiring alteration in therapy and additional expense, and they occasionally result in death. The elderly, often those with the more severe infections, may be especially prone. | Chapter 127. Treatment and Prophylaxis of Bacterial Infections Part 11 Adverse Reactions Adverse drug reactions are frequently classified by mechanism as either dose-related toxic or unpredictable. Unpredictable reactions are either idiosyncratic or allergic. Dose-related reactions include aminoglycoside-induced nephrotoxicity linezolid-induced thrombocytopenia penicillin-induced seizures and vancomycin-induced anaphylactoid reactions. Many of these reactions can be avoided by reducing dosage in patients with impaired renal function limiting the duration of therapy or reducing the rate of administration. Adverse reactions to antibacterial agents are a common cause of morbidity requiring alteration in therapy and additional expense and they occasionally result in death. The elderly often those with the more severe infections may be especially prone to certain adverse reactions. The most clinically relevant adverse reactions to common antibacterial drugs are listed in Table 127-7. For further discussion of adverse drug reactions see Chap. 5. Table 127-7 Most Clinically Relevant Adverse Reactions to Common Antibacterial Drugs Drug Adverse Event Comments P-Lactams Allergies in 1- 4 of treatment courses Cephalosporin s cause allergy in 24 of penicillinallergic patients. Aztreonam is safe in P-lactam-allergic patients. Nonallergic skin reactions Ampicillin rash is common among patients with Epstein-Barr virus infection. Diarrhea including Clostridium difficile colitis Chap. 123 Vancomycin Anaphylactoid reaction red man syndrome Give as a 1- to 2-h infusion. Nephrotoxicity ototoxicity allergy neutropenia Rare Aminoglycosides Nephrotoxicity generally reversible Greatest with prolonged therapy in the elderly or with preexisting renal insufficiency. Monitor serum creatinine every .

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