Table 1. Systemic Adverse Effects of Common Antibiotics and Classes
| ANTIBIOTIC CLASS | ANTIBIOTIC CLASS MEMBERS | MOST COMMON SIDE EFFECTS | ADDITIONAL CLINICAL COMMENTS |
|---|---|---|---|
| Penicillins | penicillin, amoxicillin, amoxicillin-clavulanate, ampicillin, piperacillin-tazobactam, nafcillin, oxacillin | rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions | if bloody stools, anaphylaxis, severe skin reaction, fever occur contact health care provider immediately; ampicillin may cause pseudomembranous colitis |
| Cephalosporins | cephalexin, cefaclor, cefuroxime, ceftibuten, cefdinir, cefixime, ceftriaxone | rash, diarrhea, nausea/vomiting (rare), hypersensitivity (allergic) reactions, serum sickness, vaginal candidiasis | cross-hypersensitivity may occur in patients with documented penicillin allergy |
| Aminoglycosides | gentamicin, tobramycin, amikacin | renal (kidney) toxicity, ototoxicity (hearing loss), dizziness, nausea/vomiting, nystagmus | longer or multiple treatment periods may lead to greater risk for ototoxicity, renal (kidney) toxicity |
| Carbapenems | meropenem, ertapenem, doripenem, imipenem-cilastatin | diarrhea, nausea/vomiting, headache, rash, liver toxicity, eosinophilia (elevated white blood cells) | Hypersensitivity reactions reported with meropenem, imipenem in patients with penicillin allergy |
| Antituberculosis Agents | rifampin, rifabutin, isoniazid, pyrazinamide, ethambutol, dapsone | diarrhea, nausea/vomiting, anorexia, hemolytic anemia, liver toxicity, headache, peripheral neuropathy, dizziness, reddish-orange body fluids (rifampin, rifabutin only) | sides effects vary among agents, check individually; vitamin B6 (pyridoxine) may be taken to help prevent peripheral neuropathy with isoniazid |
| Glycopeptides | vancomycin, telavancin | vancomycin: red man syndrome (flushing, hypotension, itching); phlebitis; telavancin: taste alteration, nausea/vomiting, headache, dizziness | IV infusion of vancomycin over 60 minutes may prevent red man syndrome |
| Macrolides | erythromycin, azithromycin, clarithromycin | abdominal pain, diarrhea, anorexia, nausea/vomiting, taste alterations (clarithromycin) | high rate of gastrointestinal side effects; do not crush, chew, break, open enteric-coated or delayed-release pill |
| Sulfonamides | trimethoprin-sulfamethoxazole, erythromycin-sulfisoxazole, sulfadiazine | nausea/vomiting, diarrhea, anorexia, abdominal pain, rash, photosensitivity, headache, dizziness | Avoid prolonged sunlight exposure; use sunscreen, wear protective clothing; antibiotic cause of Stevens Johnson Syndrome, Toxic Epidermal Necrolysis |
| Tetracyclines | tetracycline, doxycycline, minocycline | nausea/vomiting, diarrhea, anorexia, abdominal pain, tooth discoloration in children < 8 years, liver toxicity | Avoid prolonged sunlight exposure; use sunscreen, wear protective clothing |
| Quinolones | ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin) | nausea/vomiting, diarrhea, abdominal pain, headache, lethargy, insomnia, photosensitivity (can be severe) | Avoid prolonged sunlight exposure; use sunscreen, wear protective clothing; moxifloxacin associated with higher rates of side effects [shehab]; tendon rupture (rare) more common in age > 60, with corticosteroid use, in kidney, heart, lung translant recipients |
| Lincosamide | clindamycin, lincomycin | pseudomembranous colitis (may be severe), diarrhea, nausea/vomiting, rash, hypersensitivity, jaundice (clindamycin) | if severe diarrhea during treatment or for up to 8 weeks after treatment consult health care provider immediately, may be pseudomembranous colitis (C. dificile); consider use of less toxic agents |
| Miscellaneous | metronidazole | nausea/vomiting, dizziness, headache, vaginal candidiasis, metallic taste | avoid alcohol use during treatment and for up to 3 days after, combined use may lead to cramps, nausea/vomiting, flushing, headache; may discolor urine red-brown |
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