HIGH YIELD: Tested “Odd” Side Effects of Antibiotics

Drug (class) Side Effect Drug (class) Side Effect

Penicillins Type I – IV hypersensitivity Erythromycin P450 inhibitor (best motilin
activator)
Cephalosporins Hemolysis, possible K Chloramphenicol Gray baby, aplastic anemia,
deficiency, disulfiram-like P450 inducer
Imipenem (with Seizures Clindamycin Cause of C. difficle infection
cilistatin)
Vancoymycin Histamine release (flushing) Fluoroquinolones Tendon issues, QT
prolongation
Aminoglycosides NM blockade (decreased Sulfonamides Hemolysis in G6PD, Stevens-
ACh) Johnson
Linezolid Serotonin syndrome (it’s a Trimethoprim, Megaloblastic anemia (no
MAOI inhibitor) pyrimethamine nucleotides)
Tetracycline Children have bone Rifampin Red metabolites, P450
issues/brown teeth inducer
Macrolides QT prolongation Isoniazid B6 deficiency
 High-Yield Antifungal Side Effects
• Pharmacokinetics:
• Effective orally
• Absorption of ketoconazole  by antacids
• Only fluconazole penetrates into CSF and can be used in meningeal infection
• Inhibition of hepatic P450s Esp. ketoconazole!

Other Side Effects:

• Flucytosine: Megaloblastic anemia
• Griseofulvin: Taken orally, only on skin infections; disulfiram-like
• Amphotericin B: Hypotension (histamine release), nephrotoxicity includes  GFR, tubular
acidosis ( K+,  Mg++), and anemia ( erythropoietin)
• Nystatin: Taken orally (swish and swallow); IV? Will kill patient.
 NRTIs and Tested Side Effects
Drug Side Effects
Zidovudine, ZDV (AZT) • Hematotoxicity (major and dose-limiting)
• Headache, asthenia, myalgia, myopathy, peripheral neuropathy
Didanosine, DDI • Pancreatitis (major and dose-limiting)
• Peripheral neuropathy, hyperuricemia, liver dysfunction
Zalcitabine, DDC • Peripheral neuropathy (major and dose-limiting)
• GI distress, pancreatitis, neutropenia, rash
Stavudine, D4T • Peripheral neuropathy (major and dose-limiting)
• Myelosuppression < zidovudine
 NRTIs and Tested Side Effects
Drug Side Effects
Lamivudine, 3TC • Least toxic of the NRTIs, but some GI effects and neutropenia
• Active in hepatitis B
Emtricitabine, FTC • Most tolerated (fewest side effects)
• Hyperpigmentation of the skin (esp. sun-exposed areas)
Abacavir, ABC • Most potent in vivo
• 5% of patients are allergic
Tenofovir, TDF • Flatulence
(Nucleotide RTI  just needs to • Fanconi’s syndrome
have two phosphates added b/c it
already has one to begin with)