Antibiotics - Common Side Effects, Allergies and Reactions

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Common Side Effects from Antibiotics, and Allergies and

Reactions
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 15, 2021.

Common Side Effects | Should I Stop? | Allergies | Antibiotics for Cold, Flu or
COVID? | Antibiotic List and Side Effects | More Resources

What Are the Most Common Side Effects of Antibiotics?

All medications have side effects, including antibiotics. Antibiotics are medications
that treat infections by killing bacteria or other organisms or slowing their growth.
An antibiotic side effect occurs as an unwanted reaction that occurs in addition to
the desirable therapeutic action of the antibiotic you are taking.

Side effects of antibiotics can range from mild allergic reactions to severe and
debilitating adverse events. When used appropriately, most antibiotics are relatively
safe with few side effects. However, some side effects may interfere with your
ability to finish the medication. In these cases, you should contact your doctor.

Common side effects with antibiotics include:

Mild skin rash or other allergic reactions

Soft stools, short-term diarrhea

Upset stomach, nausea

Loss of appetite

Fungal (yeast) vaginal infections or oral thrush 

More severe antibiotic side effects include:

Severe allergic reaction that results in difficulty breathing, facial swelling (lips,
tongue, throat, face)

Severe watery or bloody diarrhea; Clostridium difficile infection

Stomach cramps

Yeast infections in the mouth or vagina (white discharge and severe itching in
the vagina or mouth sores or white patches in your mouth or on your tongue)

These side effects are extremely variable; however, there are some common side
effects that may occur within larger antibiotic drug classes, as described in Table 1.
Long term side effects of antibiotics can occur, but are infrequent.

Should I Stop My Antibiotic If I'm Having a Side Effect?

If you are experiencing a bothersome or serious antibiotic side effect, you should
contact your health care provider to discuss your symptoms. The outcomes may
include:

Staying on the same antibiotic and managing the side effect

Adjusting the dose

Switching to a different antibiotic

In most cases, all antibiotic treatment should be finished unless your healthcare
prover tells you otherwise. Stopping antibiotics early may allow the infection to
worsen and may lead to antibiotic resistance, making the antibiotic less effective.
Even if the infection appears to have cleared up before all of the medication is gone,
finish your treatment unless your doctor tells you to stop.

Antibiotic Allergies

Antibiotic allergies or hypersensitivity reactions are some of the most common side
effects of antibiotics leading to emergency room admission.1 Always tell your doctor
of any previous allergic reaction to any medication, including antibiotics. Mild
allergic reactions may only result in a skin rash or itch. A more severe allergic
reaction, called anaphylaxis, is a life-threatening medical emergency that requires
immediate medical attention.

Anaphylactic reactions due to antibiotics may include:

 Shortness of breath

Wheezing

Severe nausea/vomiting

Lightheadedness, dizziness

Fast heart rate

Swelling of the face, lips or tongue

Shock

Immediately call 911 for medical help if any of these symptoms should appear after
taking an antibiotic.

Antibiotics 101

List of Common Antibiotics & Types

Antibiotics and Alcohol

Probiotics and Antibiotics

Antibiotics for Strep Throat

Antibiotics for a Tooth Infection

Antibiotics for UTI's

Are Antibiotics Effective for a Cold, Flu or COVID?

Antibiotics are used to kill bacterial infections; they are not effective against viral
infections, such as a cold, the flu, COVID. They also do not work against fungal
infections, like ringworm or vaginal yeast infections.

You should avoid demanding an antibiotic from your healthcare provider when you
have a viral infection as it will not cure your infection and might make it worse. In
addition, this adds to the problem of antibiotic resistance, and it costs you money
you do not need to spend. Your doctor can offer symptomatic treatment to ease your
viral infection, or prescribe specific anti-viral medications if appropriate.

If you eventually need an antibiotic because of a secondary bacterial infection that

might occur later, your doctor will prescribe it then.

List of Antibiotics and Their Side Effects

There are several side effects that are common to most antibiotics, regardless of
class or drug. These side effects may include:

antibiotic-associated diarrhea

yeast infections (vaginal, oral)

anaphylaxis

serious allergic skin reactions, other allergic reactions

complications from intravenous (IV) use of antibiotics (phlebitis)

What are the side effects of antibiotics? The most common antibiotic classes and
drug members are listed in Table 1, along with the most commonly reported
antibiotic side effects (list are not comprehensive). 

Table 1: Common Antibiotic Side Effects*

Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

If bloody stools, an
extreme watery
penicillin diarrhea, stools
with pus,
amoxicillin anaphylaxis (a
(Amoxil) skin rash
severe allergy),
amoxicillin and diarrhea urgent stomach
List of penicillins, clavulanate pain, severe skin
stomach pain
penicillinase- (Augmentin) reaction, or fever
resistant nausea and occur contact health
penicillins, and ampicillin vomiting care provider
other penicillin- piperacillin and immediately.
drug fever
type drugs tazobactam
(Zosyn) hypersensitivity Antibiotics may
(allergic) reactions cause life-
nafcillin  threatening
oxacillin pseudomembranous
colitis and
Clostridium difficile
infection.
Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

Cross-
hypersensitivity
may occur in
patients with
cephalexin documented
(Keflex) penicillin allergy;
may be more
cefaclor   common with first
cefadroxil generation
(Duricef) cephalosporins due
rash to structural
cefazolin  diarrhea similarities.
cefepime nausea and
(Maxipime) In one prospective
vomiting (rare)
List of study2, the rate of
cefotaxime hypersensitivity cross-reactivity
cephalosporins (Claforan) (allergic) reactions among subjects with
ceftaroline serum sickness a positive penicillin
(Teflaro) skin test was 6%;
vaginal candidiasis however rates up to
cefuroxime (yeast infection)  10% have been
(Ceftin, Zinacef) reported.
cefdinir
If you have a history
cefixime of penicillin allergy,
ceftriaxone your doctor may
recommend
penicillin skin
testing if a
cephalosporin is
required.
Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

Aztreonam (Azactam, IV)

aztreonam
(Azactam,
Cayston)
The monobactams
have a unique
structure and are
different from other
beta-lactam antibiotics
(eg, penicillins,
List of
monobactams cephalosporins,
cephamycins).  Aztreonam (Cayston,
inhalation)
Cayston (aztreonam)
inhalation is used in
people who have
cystic fibrosis and a
certain bacteria in
their lungs. This helps
to improve their
breathing symptoms.
nausea, vomiting
While cross-
diarrhea reactivity of
aztreonam
rash
(Azactam) with
vaginal itching or other beta-lactam
discharge antibiotics is rare, 
pain, bruising, use with caution to
swelling, or any patient with a
irritation where the history of
medicine was hypersensitivity to
injected beta-lactams (eg,
penicillins,
cephalosporins,
and/or
carbapenems).6,8 
cough, wheezing Treatment with
nasal congestion,  aztreonam can
result in
throat pain hypersensitivity
fever reactions in patients
with or without
chest discomfort
prior exposure.
stomach pain and
vomiting

Aminoglycosides
renal (kidney) are often reserved
toxicity for times when less
toxic antibiotics
amikacin ototoxicity (hearing cannot be used or
(Amikin, loss) are ineffective.
Arikayce) dizziness
Aminoglycosides
gentamicin nausea and are not well
(Garamycin) vomiting absorbed by mouth,
neomycin nystagmus and are usually
List
(involuntary eye given by injection.
of aminoglycosides tobramycin
movement) Some products are
(Bethkis, Tobi)
given by inhalation
plazomicin Long-term for lung infection.
(Zemdri) aminoglycosides or
multiple treatment Neomycin is given
paromomycin
periods may lead to by mouth for its
(Humatin)
greater risk for effects in the
ototoxicity (hearing intestine, although
damage, loss) and renal it can be absorbed
(kidney) toxicity. and toxic reactions
may occur.
Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

diarrhea
nausea and
meropenem vomiting
(Merrem) Hypersensitivity
headache
ertapenem reactions reported
List (Invanz) rash with meropenem
of carbapenems and imipenem in
imipenem and hepatic (liver)
patients with
cilastatin toxicity
penicillin allergy.
(Primaxin) eosinophilia (high
levels of a type of
white blood cell)

dapsone
diarrhea
ethambutol
(Myambutol) nausea and
vomiting
isoniazid
anorexia Sides effects vary
pyrazinamide among agents,
hemolytic anemia check each
rifabutin
liver toxicity individually.
(Mycobutin)
List of
antituberculosis rifampin (Rifadin, headache Vitamin B6
agents Rimactane) peripheral (pyridoxine) may be
neuropathy taken to help
isoniazid,
prevent peripheral
pyrazinamide, dizziness neuropathy with
and rifampin
reddish-orange isoniazid.
(Rifater)
body fluids (with
isoniazid and rifampin, rifabutin
rifampin only)
(Rifamate)

IV infusion of
telavancin vancomycin over 60
vancomycin: "red minutes may help to
(Vibativ)
man syndrome" prevent RMS.
vancomycin (RMS) - flushing,
(Vancocin, hypotension, itching Other cases of RMS
Firvanq) with IV use; due to other
List
phlebitis antibiotics have
of glycopeptides oritavancin
(Orbactiv, telavancin: taste been reported,
Kimyrsa) alteration, including: rifampin,
nausea/vomiting, cefepime,
dalbavancin teicoplanin,
headache, dizziness
(Dalvance) ciprofloxacin, and
amphotericin B.7
Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

azithromycin
(Azithromycin, Z
Pak) abdominal pain High rate of
diarrhea gastrointestinal
clarithromycin
(stomach) side
(Biaxin) appetite loss effects.
List of macrolide
erythromycin nausea and
antibiotics
(E.E.S., EryPed, vomiting Do not crush, chew,
Ery-Tab, break, open enteric-
Erythrocin) taste alterations coated or delayed-
(clarithromycin) release pills.
fidaxomicin
(Dificid)

nausea and
vomiting
Sulfonamide
diarrhea allergic reactions
sulfacetamide anorexia (appetite have been reported
sodium topical loss) in roughly 1.5% to
(Klaron, Ovace) 3% of the general
abdominal (stomach
sulfadiazine population. Learn
pain)
List of (generic) more about sulfa
sulfonamides rash allergies here.
(antibiotic) sulfamethoxazole 
and trimethoprim headache
May lead to severe
(Bactrim, Co- dizziness skin reactions:
trimoxazole, Stevens Johnson
Septa, SMZ-TMP) photosensitivity
Syndrome, Toxic
Avoid prolonged sunlight Epidermal
exposure; use sunscreen, Necrolysis.
and wear protective
clothing.

tetracycline nausea and

(Achromycin V) vomiting

doxycycline diarrhea
(Doryx, Oracea, anorexia The development of
Monodox bacterial resistance
Vibramycin) abdominal has limited the
(stomach) pain effectiveness of this
List eravacycline
tooth discoloration class of drugs,
of tetracyclines (Xerava)
in children < 8 years although they may
minocycline still be used in
(Solodyn, liver toxicity human and animal
Minocin) photosenstivity medicine.
omadacycline
(Nuzyra) Avoid prolonged sunlight
exposure, use sunscreen,
sarecycline wear protective clothing.
(Seysara)
Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

Due to a risk for

serious adverse
reactions, doctors
may withhold use of
this class unless
delafloxacin absolutely required
(Baxdela) for more serious or
nausea and unresponsive
ciprofloxacin
vomiting infections.
(Cipro)
diarrhea
ciprofloxacin Avoid prolonged
extended-release abdominal sunlight exposure;
(Cipro XR) (stomach) pain use sunscreen, wear
List of
gemifloxacin headache protective clothing.
fluoroquinolones
(quinolones) (Factive)
lethargy See FDA alerts and
levofloxacin boxed warnings for
insomnia (difficulty
(Levaquin) fluoroquinolones:
sleeping)
moxifloxacin tendon rupture,
photosensitivity tendonitis,
(Avelox)
(can be severe) peripheral
ofloxacin neuropathy,
(generic) aggravation of
myasthenia gravis,
aortic aneurysm or
dissection, low
blood sugar, mental
status changes. 

pseudomembranous
colitis (may be If severe diarrhea
severe and life- during treatment or
threatening) for up to 8 weeks
after treatment
clindamycin diarrhea consult health care
(Cleocin)
List of lincomycin nausea and provider
derivatives lincomycin vomiting immediately, may
(Lincocin) be
rash
pseudomembranous
allergies colitis (C. difficile);
consider use of less
jaundice
toxic agents.
(clindamycin)
Common Antibiotic Antibiotic Class Most Common Class Side Additional Clinical
Classes Members Effects Comments

Avoid alcohol use

and or propylene
metallic taste glycol use during
treatment and for
nausea and up to 3 days after
vomiting treatment stopped.
Miscellaneous metronidazole
dizziness
antibiotics (Flagyl) Combined use with
headache alcohol may lead to
vaginal yeast cramps,
infections nausea/vomiting,
flushing, headache;
may discolor urine
red-brown.

*This is not a complete list of common antibiotics or side effects that may occur. For
a complete list of side effects, please refer to the individual drug monographs.

Side Effects

Allergic Reactions, Anaphylaxis: Allergic reactions account for the most common
type of side effect with antibiotics.

Previous research showed that 142,000 emergency department visits per year
were due to antibiotic adverse events, and approximately 80% of these events
were due to allergic reactions.

Allergic reactions can typically only be prevented by avoiding the drug, although
desensitization may be possible in certain circumstances for patients who have
no other antibiotic options.1

Skin testing may be recommended for some instances of a reported penicillin

allergy, when other drug classes are not optimal.2

Anaphylaxis is the most serious type of allergic reaction and can be life-
threatening.

Antibiotic-associated diarrhea: Antibiotic-associated diarrhea occurs in patients

receiving antibiotics.

About 5% to 25% of patients may develop antibiotic-associated diarrhea at any

one time. The diarrhea occurs due to eradication of the normal gut flora by the
antibiotic and results in an overgrowth of infectious bacteria, such as
Clostridium difficile.
 If the diarrhea is severe, bloody, contains pus, or is accompanied by stomach
cramps, fever or vomiting, a physician should be contacted.

The most common antibiotics implicated in antibiotic-associated diarrhea are

amoxicillin-clavulanate, ampicillin, and cefixime; however, other antibiotics
may lead to this side effect, including cephalosporins, fluoroquinolones (e.g.,
side effects of Cipro antibiotic), azithromycin (e.g., Azithromycin, Z Pak),
clarithromycin (Biaxin), erythromycin, and tetracycline.3

Probiotics such as Saccharomyces boulardii (Florastor) have been shown to be

effective in helping to prevent antibiotic-associated diarrhea in children and
adults.5

Vaginal yeast infections or oral thrush (candida species): Antibiotics may also
change the normal flora balance in the vagina, often leading to an overgrowth of
fungal species.

Candida albicans is a common fungus normally present in small amounts in the

vagina, mouth, gastrointestinal tract and on the skin and does not normally
cause disease or symptoms. However, the fungus may take over when there is
limited competition from bacteria due to antibiotic treatment.

Thrush may appear as white patches in the mouth or on the tongue, and vaginal
yeast infections produce a white discharge and intense itching. 

Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN): Stevens-

Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious
allergic reactions to substances, often medications, that result in severe skin and
mucous membrane disorders.

Antibiotics such as sulfonamides, penicillins, cephalosporins, and

fluoroquinolones may result in SJS and TEN.

SJS and TEN can both cause rash, skin peeling, and sores on the mucous
membranes and may be life-threatening.4 

Injection site reactions or phlebitis: A reaction to an antibiotic can occur if the

antibiotic is given intravenously (IV) into a vein.

Injections site reactions and phlebitis (vein inflammation) can occur. The vein
and area with the IV needle may be red, swollen and hot. An infection may or
may not be present.
 Typically, the needle must be removed and reinserted elsewhere to help clear
the injection site reaction.

Antibiotics are among the most commonly prescribed medications in the US.
However, many side effects may not be reported. Always consult your doctor or
healthcare specialist for medical advice.

You may also report side effects to the FDA or call 1-800-FDA-1088 (1-800-332-1088).

See also

Alcohol and Antibiotic Interactions

Antibiotic Resistance: The Top 10 List

Antibiotic Shortages: A Serious Safety Concern

Antibiotics and Birth Control Pill Interactions

Antibiotics for UTI Treatment

Middle Ear Infection FAQs (Acute Otitis Media)

Why Don’t Antibiotics Kill Viruses?

Learn more

Antibiotics Guide

Anticholinergic Drugs to Avoid in the Elderly

Four Common Sexually Transmitted Diseases: Take Away Points

Treatment options

Medications for Bacterial Infection

Medications for Bladder Infection

Medications for Chlamydia Infection

Medications for Clostridioides difficile Infection

Medications for Diarrhea, Acute

Medications for Otitis Media

Medications for Pseudomembranous Colitis

Care guides

C. Diff (Clostridioides Difficile) Infection

Catheter-Associated Urinary Tract Infection

Gonorrhea

Infectious Colitis

Interstitial Cystitis

Kidney Infection

Nonspecific Urethritis in Men

Symptoms and treatments

Acute Sinusitis

Bladder Infection (Cystitis)

Medicine.com guides (external)

Bacterial Infection Guide

Chlamydia Guide

Otitis Media Guide

Sources

1. Shehab N, Patel P, Srinivasan A, et al. Emergency department visits for

antibiotic-associated adverse events. Clinical Infectious Diseases 2008;47:735-43.

2. Park MA, Koch CA, Klemawesch P, Joshi A, Li JT. Increased adverse drug
reactions to cephalosporins in penicillin allergy patients with positive penicillin
skin test. Int Arch Allergy Immunol. 2010;153(3):268-273. doi: 10.1159/000314367.

3. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med

2002:346:334-9.

4. The Merck Manual for Health Care Professionals. Stevens-Johnson Syndrome

(SJS) and Toxic Epidermal Necrolysis (TEN).

5. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Saccharomyces

boulardii in the prevention of antibiotic-associated diarrhoea. Aliment
 Pharmacol Ther. 2015 Oct;42(7):793-801. doi: 10.1111/apt.13344. 

6. Eljaaly K, Stevens R. Penicillin Allergies and Cross-Reactivity With Other Beta-

Lactams. May 17, 2017. Pharmacy Times. Health System Edition.

7. Martel TJ, Jamil RT, King KC. Red Man Syndrome. [Updated 2019 Jun 6]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan.

8. Aztreonam package labeling. Bristol Myers Squibb. Rev. Sept 2018. Accessed
Sept. 15, 2021 at https://packageinserts.bms.com/pi/pi_azactam.pdf

Further information

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