Adverse reaction of antibiotics: Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice

27.09.202308.07.2023 by alexxlab

What are the adverse effects of antimicrobial therapies in community practice? How can antibiotic allergy be managed? What is the association between antibiotic use and resistance? What are the implications of antibiotic-resistant infections in the community?

Содержание

Adverse Effects of Antimicrobial Therapies in Community Practice

Antimicrobial therapies, particularly antibiotics, play a crucial role in managing infections in community practice. However, the use of these medications is not without risks. Several studies have highlighted the adverse effects and implications of inappropriate antibiotic prescribing in outpatient settings.

A study published in the BMJ emphasized the importance of optimizing antibiotic prescribing in outpatient settings to minimize adverse effects and the development of antibiotic resistance.¹ The authors noted that up to 30% of outpatient antibiotic prescriptions may be inappropriate, leading to adverse drug reactions, increased healthcare costs, and the spread of antibiotic-resistant pathogens.

Antibiotic Hypersensitivity and Adverse Reactions

One of the significant adverse reactions associated with antibiotics is hypersensitivity. Antibiotic allergy can manifest in various ways, including immediate IgE-mediated reactions, delayed T-cell-mediated reactions, and even life-threatening conditions like Stevens-Johnson syndrome.² Proper management of antibiotic allergy is crucial to ensure patient safety and optimize antibiotic therapy.

A review article in Clinical and Experimental Allergy provided guidelines for the management of allergy to penicillins and other beta-lactam antibiotics, which are among the most commonly prescribed antibiotics.³ The authors emphasized the importance of accurate diagnosis, avoidance of cross-reactivity, and the use of alternative antibiotics when necessary.

Antibiotic Use and Resistance

The use of antibiotics in outpatient settings has been associated with the development of antibiotic resistance. A cross-national database study published in The Lancet demonstrated a strong correlation between outpatient antibiotic use and antibiotic resistance in Europe.⁴ This association highlights the need for antimicrobial stewardship programs in community-based settings to promote the judicious use of antibiotics.

Another study, published in PLOS Medicine, showed that antibiotic selection pressure can lead to the development of macrolide resistance in Streptococcus pneumoniae, a common respiratory pathogen.⁵ This study underscores the importance of appropriate antibiotic selection and the need for ongoing surveillance of antibiotic resistance patterns in the community.

Implications of Antibiotic-Resistant Infections

The rise of antibiotic-resistant infections in the community setting is a significant public health concern. A review on antimicrobial resistance, commissioned by the Wellcome Trust, emphasized the global impact of drug-resistant infections and called for international collaborative action to address this issue.⁷

One study published in the Journal of Antimicrobial Chemotherapy found that prior antibiotic therapy was associated with an increased risk of subsequent community-acquired infections, including those caused by antibiotic-resistant pathogens.⁸ This highlights the need for strategies to mitigate the unintended consequences of antibiotic use in the community.

Clostridium difficile Infection and Antibiotic Use

Antibiotic use has also been linked to the development of Clostridium difficile infection (CDI), a serious and potentially life-threatening condition. A study published in the International Journal of Medical Sciences found that certain antibiotic classes, such as fluoroquinolones and cephalosporins, were associated with a higher risk of CDI.¹⁰ The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have published guidelines for the management of CDI in adults and children.¹¹

Adverse Effects of Specific Antibiotic Classes

In addition to the general adverse effects of antibiotics, certain antibiotic classes have been associated with specific safety concerns. For example, the U.S. Food and Drug Administration has issued warnings about the disabling side effects of fluoroquinolone antibiotics, such as tendinitis, neuropathy, and mental health issues.¹²

A study published in the BMJ found that the duration of antibiotic treatment for common infections in primary care often exceeded the recommendations in clinical guidelines.¹³ Prolonged antibiotic use can increase the risk of adverse events and the development of antibiotic resistance.

Pharmacogenetics and Adverse Drug Reactions

The field of pharmacogenetics has provided insights into the genetic factors that can influence an individual’s response to medications, including antibiotics. A review article in The Lancet highlighted the importance of understanding pharmacogenetics in the context of adverse drug reactions.¹⁴ Incorporating pharmacogenetic testing into clinical practice may help identify patients at higher risk of adverse reactions and guide more personalized antibiotic therapy.

In a study published in JAMA Internal Medicine, researchers found an association between adverse events and antibiotic use in hospitalized patients.¹⁵ This emphasizes the need for careful monitoring and management of antibiotic-related adverse events, even in the inpatient setting.

Pharmacovigilance, the science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other medicine-related problem, plays a crucial role in ensuring the safe use of antibiotics and other medications.¹⁶ Regulatory agencies, such as Health Canada and the Medicines and Healthcare products Regulatory Agency in the UK, monitor and communicate information about drug safety issues.^17,18

In conclusion, the adverse effects of antimicrobial therapies in community practice, including antibiotic hypersensitivity, resistance, and Clostridium difficile infection, highlight the need for improved antibiotic stewardship and the implementation of strategies to minimize the negative consequences of antibiotic use. Ongoing pharmacovigilance, the consideration of pharmacogenetics, and the adherence to clinical guidelines are essential to ensure the safe and effective use of antibiotics in community-based settings.

Update on the adverse effects of antimicrobial therapies in community practice

1. King LM, Fleming-Dutra KE, Hicks LA. Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ. 2018;363:k3047. [PMC free article] [PubMed] [Google Scholar]

2. Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183–98. Epub 2018 Dec 14. [PMC free article] [PubMed] [Google Scholar]

3. Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, et al. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy. 2015;45(2):300–27. [PubMed] [Google Scholar]

4. Goossens H, Ferech M, Stichele RV, Elseviers M, ESAC Project Group Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87. [PubMed] [Google Scholar]

5. Skalet AH, Cevallos V, Ayele B, Gebre T, Zhou Z, Jorgensen JH, et al. Antibiotic selection pressure and macrolide resistance in nasopharyngeal Streptococcus pneumoniae: a cluster-randomized clinical trial. PLoS Med. 2010;7(12):e1000377. [PMC free article] [PubMed] [Google Scholar]

6. Wi T, Lahra MM, Ndowa F, Bala M, Dillon JAR, Ramon-Pardo P, et al. Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action. PLoS Med. 2017;14(7):e1002344. [PMC free article] [PubMed] [Google Scholar]

7. Tackling drug-resistant infections globally: final report and recommendations. London, Engl: Wellcome Trust; 2016. Review on Antimicrobial Resistance. Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf. Accessed 2020 Jul 28. [Google Scholar]

8. Malik U, Armstrong D, Ashworth M, Dregan A, L’Esperance V, McDonnell L, et al. Association between prior antibiotic therapy and subsequent risk of community-acquired infections: a systematic review. J Antimicrob Chemother. 2018;73(2):287–96. [PubMed] [Google Scholar]

9. Schechner V, Temkin E, Harbarth S, Carmeli Y, Schwaber MJ. Epidemiological interpretation of studies examining the effect of antibiotic usage on resistance. Clin Microbiol Rev. 2013;26(2):289–307. [PMC free article] [PubMed] [Google Scholar]

10. Teng C, Reveles KR, Obodozie-Ofoegbu OO, Frei CR. Clostridium difficile infection risk with important antibiotic classes: an analysis of the FDA adverse event reporting system. Int J Med Sci. 2019;16(5):630–5. [PMC free article] [PubMed] [Google Scholar]

11. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) Clin Infect Dis. 2018;66(7):e1–48. [PMC free article] [PubMed] [Google Scholar]

12. US Food and Drug Administration . FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Silver Spring, MD: US Food and Drug Administration; 2018. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics. Accessed 2019 Aug 13. [Google Scholar]

13. Pouwels KB, Hopkins S, Llewelyn MJ, Walker AS, McNulty CA, Robotham JV. Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines. BMJ. 2019;364:l440. [PMC free article] [PubMed] [Google Scholar]

14. Meyer UA. Pharmacogenetics and adverse drug reactions. Lancet. 2000;356(9242):1667–71. [PubMed] [Google Scholar]

15. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med. 2017;177(9):1308–15. [PMC free article] [PubMed] [Google Scholar]

16. Waller P, Harrison-Woolrych M., editors. An introduction to pharmacovigilance. 2nd ed. Chichester, Engl: Wiley-Blackwell; 2017. What is pharmacovigilance and how has it developed? p. 33. [Google Scholar]

17. Health Canada . Drug and health products. Ottawa, ON: Government of Canada; 2019. Available from: https://www.canada.ca/en/services/health/drug-health-products.html. Accessed 2019 Aug 13. [Google Scholar]

18. Medicines & Healthcare products Regulatory Agency . Drug safety update. London, Engl: GOV.UK; Available from: https://www.gov.uk/drug-safety-update. Accessed 2019 Aug 13. [Google Scholar]

19. European Medicines Agency . European Medicines Agency recommends restricting the use of oral moxifloxacin-containing medicines [press release] Amsterdam, The Netherlands: European Medicines Agency; 2008. Available from: https://www.ema.europa.eu/en/news/european-medicines-agency-recommends-restricting-use-oral-moxifloxacin-containing-medicines. Accessed 2020 Aug 12. [Google Scholar]

20. Therapeutic Goods Administration . Safety information. Canberra, Aust: Australian Government; Available from: https://www.tga.gov.au. Accessed 2019 Aug 13. [Google Scholar]

21. Medsafe [website] Wellington, NZ: New Zealand Medicines and Medical Devices Safety Authority; Available from: https://www.medsafe.govt.nz/. Accessed 2019 Aug 13. [PubMed] [Google Scholar]

22. CIOMS Working Group IV . Benefit-risk balance for marketed drugs: evaluating safety signals. Geneva, Switz: Council for International Organizations of Medical Sciences; 1998. Available from: https://cioms.ch/wp-content/uploads/2017/01/benefit-risk.pdf. Accessed 2020 Jul 28. [Google Scholar]

23. Bhattacharya S. The facts about penicillin allergy: a review. J Adv Pharm Technol Res. 2010;1(1):11–7. [PMC free article] [PubMed] [Google Scholar]

24. Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ. 2018;361:k2400. [PMC free article] [PubMed] [Google Scholar]

25. Gillies M, Ranakusuma A, Hoffmann T, Thorning S, McGuire T, Glasziou P, et al. Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. CMAJ. 2015;187(1):E21–31. Epub 2014 Nov 17. [PMC free article] [PubMed] [Google Scholar]

26. Knowles S. Drug allergies: a review. Pharmacy Practice. 2005 Apr; Available from: http://www.canadianhealthcarenetwork.ca/files/2009/10/PPRCE_APR05.pdf. Accessed 2020 Jul 28. [Google Scholar]

27. Hum SW, Shaikh KJ, Musa SS, Shaikh N. Adverse events of antibiotics used to treat acute otitis media in children: a systematic meta-analysis. J Pediatr. 2019;215:139–43.e7. Epub 2019 Sep 24. [PubMed] [Google Scholar]

28. Kellen PE. Diaper dermatitis: differential diagnosis and management. Can Fam Physician. 1990;36:1569–72. [PMC free article] [PubMed] [Google Scholar]

29. Jappe U. Amoxicillin-induced exanthema in patients with infectious mononucleosis: allergy or transient immunostimulation? Allergy. 2007;62(12):1474–5. [PubMed] [Google Scholar]

30. Amoxil [product monograph] Research Triangle Park, NC: GlaxoSmithKline; 2006. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/050542s24,050754s11,050760s10,050761s10lbl.pdf. Accessed 2020 Mar 21. [Google Scholar]

31. Blondeau JM. What have we learned about antimicrobial use and the risks for Clostridium difficile-associated diarrhoea? J Antimicrob Chemother. 2009;63(2):238–42. Epub 2008 Nov 20. [PubMed] [Google Scholar]

32. Hoofnagle JH, Björnsson ES. Drug-induced liver injury—types and phenotypes. N Engl J Med. 2019;381(3):264–73. [PubMed] [Google Scholar]

33. Kuehn J, Ismael Z, Long PF, Barker CIS, Sharland M. Reported rates of diarrhea following oral penicillin therapy in pediatric clinical trials. J Pediatr Pharmacol Ther. 2015;20(2):90–104. [PMC free article] [PubMed] [Google Scholar]

34. Jayaweera JAAS, Abeydeera WPH, Ranasinghe GR. Intravenously administered cloxacillin-induced neutropenia with eosinophilia in a patient with infective endocarditis: a case report. J Med Case Rep. 2018;12(1):384. [PMC free article] [PubMed] [Google Scholar]

35. Lee A, Thomson J. Drug-induced skin reactions. In: Lee A, editor. Adverse drug reactions. 2nd ed. London, Engl: Pharmaceutical Press; 2005. pp. 125–56. Available from: https://www.pharmpress.com/files/docs/Adverse%20Drug%20Reactions%20Sample.pdf. [Google Scholar]

36. Thompson JW, Jacobs RF. Adverse effects of newer cephalosporins. An update. Drug Saf. 1993;9(2):132–42. [PubMed] [Google Scholar]

37. Monurol [product monograph] Cadempino, Switz: Zambon; 2007. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/050717s005lbl.pdf. Accessed 2020 Feb 21. [Google Scholar]

38. Iarikov D, Wassel R, Farley J, Nambiar S. Adverse events associated with fosfomycin use: review of the literature and analyses of the FDA Adverse Event Reporting System Database. Infect Dis Ther. 2015;4(4):433–58. Epub 2015 Oct 5. [PMC free article] [PubMed] [Google Scholar]

39. Cleocin HCl [product monograph] Silver Spring, MD: US Food and Drug Administration; Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/050162s092s093lbl.pdf. Accessed 2019 Mar 9. [Google Scholar]

40. Zyvox [product monograph] New York, NY: Pfizer Inc; 2008. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021130s016,021131s013,021132s014lbl.pdf. Accessed 2020 Feb 21. [Google Scholar]

41. Hansen MP, Scott AM, McCullough A, Thorning S, Aronson JK, Beller EM, et al. Adverse events in people taking macrolide antibiotics versus placebo for any indication. Cochrane Database Syst Rev. 2019;1(1):CD011825. [PMC free article] [PubMed] [Google Scholar]

42. US Food and Drug Administration . FDA Drug Safety Communication: azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms. Silver Spring, MD: US Food and Drug Administration; 2013. Available from: https://www.fda. gov/downloads/Drugs/DrugSafety/UCM343347.pdf. Accessed 2019 Jan 30. [Google Scholar]

43. Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the risk of cardiovascular death. N Engl J Med. 2012;366(20):1881–90. [PMC free article] [PubMed] [Google Scholar]

44. Urex [product monograph] Wytheville, VA: Vatring Pharmaceuticals Inc; 2006. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/016151s025lbl.pdf. Accessed 2020 Mar 21. [Google Scholar]

45. Flagyl [product monograph] Chicago, IL: Pharmacia; 2003. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2004/12623slr059_flagyl_lbl.pdf. Accessed 2019 Mar 9. [Google Scholar]

46. Macrobid [product monograph] Cincinnati, OH: Procter and Gamble Pharmaceuticals Inc; 2009. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020064s019lbl.pdf. Accessed 2019 Oct 11. [Google Scholar]

47. AIDSinfo . Ciprofloxacin. 1. Full prescribing information. Rockville, MD: US Department of Health and Human Services; 2020. Available from: https://aidsinfo.nih.gov/drugs/458/ciprofloxacin/69/professional#nlm34066-1. Accessed 2020 Jul 28. [Google Scholar]

48. Government of Canada . Summary safety review – fluoroquinolones – assessing the potential risk of persistent and disabling side effects. Ottawa, ON: Government of Canada; 2017. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-fluoroquinolones-assessing-potential-risk-persistent-disabling-effects.html. Accessed 2020 Apr 23. [Google Scholar]

49. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008;47(6):735–43. [PubMed] [Google Scholar]

50. Morales D, Pacurariu A, Slattery J, Pinheiro L, McGettigan P, Kurz X. Association between peripheral neuropathy and exposure to oral fluoroquinolone or amoxicillin-clavulanate therapy. JAMA Neurol. 2019;76(7):827–33. [PMC free article] [PubMed] [Google Scholar]

51. Etminan M, Forooghian F, Brophy JM, Bird ST, Maberley D. Oral fluoroquinolones and the risk of retinal detachment. JAMA. 2012;307(13):1414–9. [PubMed] [Google Scholar]

52. Van Bambeke F, Tulkens PM. Safety profile of the respiratory fluoroquinolone moxifloxacin: comparison with other fluoroquinolones and other antibacterial classes. Drug Saf. 2009;32(5):359–78. [PubMed] [Google Scholar]

53. Richardson WL, Hammert WC. Adverse effects of common oral antibiotics. J Hand Surg Am. 2014;39(5):989–91. Epub 2014 Mar 5. [PubMed] [Google Scholar]

54. Gleckman R, Blagg N, Joubert DW. Trimethoprim: mechanisms of action, antimicrobial activity, bacterial resistance, pharmacokinetics, adverse reactions, and therapeutic indications. Pharmacotherapy. 1981;1(1):14–20. [PubMed] [Google Scholar]

55. Bactrim [product monograph] Philadelphia, PA: AR Scientific; 2010. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/017377s067lbl.pdf. Accessed 2020 Mar 4. [Google Scholar]

56. Minocin [product monograph] Cranford, NJ: Triax Pharmaceuticals; 2010. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/050649023lbl.pdf. Accessed 2020 Mar 21. [Google Scholar]

57. Shapiro LE, Knowles SR, Shear NH. Comparative safety of tetracycline, minocycline, and doxycycline. Arch Dermatol. 1997;133(10):1224–30. [PubMed] [Google Scholar]

58. Smith K, Leyden JJ. Safety of doxycycline and minocycline: a systematic review. Clin Ther. 2005;27(9):1329–42. [PubMed] [Google Scholar]

59. Dağ MS, Öztürk ZA, Akın I, Tutar E, Çıkman Ö, Gülşen MT. Drug-induced esophageal ulcers: case series and the review of the literature. Turk J Gastroenterol. 2014;25(2):180–4. [PubMed] [Google Scholar]

60. AIDSinfo . Vancomycin hydrochloride. 6. Adverse reactions. Rockville, MD: US Department of Health and Human Services; 2018. Available from: https://aidsinfo.nih.gov/drugs/550/vancomycin-hydrochloride/186/professional#nlm34084-4. Accessed 2020 Feb 21. [Google Scholar]

61. Diflucan [product monograph] New York, NY: Pfizer Inc; 2011. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/019949s052,019950s057,020090s036lbl.pdf. Accessed 2019 Mar 9. [Google Scholar]

62. AIDSinfo . Itraconazole. Rockville, MD: US Department of Health and Human Services; 2020. Available from: https://aidsinfo.nih.gov/drugs/44/itraconazole/59/professional. Accessed 2019 Mar 9. [Google Scholar]

63. Gupta AK, Lyons DCA. The rise and fall of oral ketoconazole. J Cutan Med Surg. 2015;19(4):352–7. Epub 2015 Mar 5. [PubMed] [Google Scholar]

64. Weiss AJ, Elixhauser A, Bae J, Encinosa W. Origin of adverse drug events in U.S. hospitals, 2011. Rockville, MD: Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality; 2016. Available from: https://hcup-us.ahrq.gov/reports/statbriefs/sb158.jsp. Accessed 2020 Jul 28. [Google Scholar]

65. Bachert A. Curbing antibiotics tied to Britain’s drop in C. diff. Medpage Today. 2017 Jan 24; Available from: https://www.medpagetoday.org/gastroenterology/generalgastroenterology/62719?vpass=1. Accessed 2020 Jul 28. [Google Scholar]

66. Garner SE, Eady A, Bennett C, Newton JN, Thomas K, Popescu CM. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database Syst Rev. 2012;(8):CD002086. [PMC free article] [PubMed] [Google Scholar]

67. Gorelik E, Masarwa R, Perlman A, Rotshild V, Muszkat M, Matok I. Systematic review, meta-analysis, and network meta-analysis of the cardiovascular safety of macrolides. Antimicrob Agents Chemother. 2018;62(6):e00438–18. [PMC free article] [PubMed] [Google Scholar]

68. Polgreen LA, Riedle BN, Cavanaugh JE, Girotra S, London B, Schroeder MC, et al. Estimated cardiac risk associated with macrolides and fluoroquinolones decreases substantially when adjusting for patient characteristics and comorbidities. J Am Heart Assoc. 2018;7(9):e008074. [PMC free article] [PubMed] [Google Scholar]

69. Tau N, Shochat T, Gafter-Gvili A, Tibau A, Amir E, Shepshelovich D. Association between data sources and US Food and Drug Administration drug safety communications. JAMA Intern Med. 2019;179(11):1–3. [PMC free article] [PubMed] [Google Scholar]

70. Royer S, DeMerle KM, Dickson RP, Prescott HC. Shorter versus longer courses of antibiotics for infection in hospitalized patients: a systematic review and meta-analysis. J Hosp Med. 2018;13(5):336–42. Epub 2018 Jan 25. [PMC free article] [PubMed] [Google Scholar]

71. Vaughn VM, Flanders SA, Snyder A, Conlon A, Rogers MAM, Malani AN, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study. Ann Intern Med. 2019;171(3):153–63. Epub 2019 Jul 9. [PubMed] [Google Scholar]

72. Tanday S. Shorter courses of antibiotic treatment for patients with pneumonia. Lancet Respir Med. 2016;4(9):691. Epub 2016 Jul 23. [PubMed] [Google Scholar]

73. Wilson HL, Daveson K, Del Mar CB. Optimal antimicrobial duration for common bacterial infections. Aust Prescr. 2019;42(1):5–9. [PMC free article] [PubMed] [Google Scholar]

74. Medicines Evidence Commentary . Antibiotic stewardship: duration of antibiotic treatment for common infections frequently exceeds guideline recommendations. London, Engl: National Institute for Health and Care Excellence; 2019. [Google Scholar]

Side effects of antibiotics

Healthcare practitioners prescribe antibiotics to prevent and treat bacterial infections. Most of the side effects of taking antibiotics are not life threatening. However, antibiotics may cause severe side effects in some people that require medical attention.

Antibiotics are generally safe, and doctors prescribe them to stop the growth of bacteria; for example, to treat bacterial infections, such as strep throat, urinary tract infections (UTIs), and certain skin infections.

Antibiotics do not work against viruses that cause most upper respiratory infections, the common cold, or COVID-19.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

However, antibiotics can cause side effects, ranging from minor to severe to life threatening. According to the Centers for Disease Control and Prevention (CDC), 1 in 5 medication-related emergency room visits are due to antibiotic side effects.

Anyone experiencing a severe antibiotic side effect should consult with a healthcare professional. A person experiencing anaphylaxis symptoms, such as difficulty breathing, chest pain, or tightness in the throat, should call 911.

This article explores common and rare side effects of antibiotics, including long term side effects and when to consult a doctor.

Learn more about bacteria here.

Whenever a person takes an antibiotic, they may experience some common side effects, such as:

Digestive problems

Digestive symptoms may include:

nausea
indigestion
vomiting
diarrhea
bloating or feeling full
loss of appetite
stomach pain or cramping

Sometimes, a person needs to take antibiotics with food; other times, they need to take them on an empty stomach. A person can speak with their doctor or a pharmacist about how best to take their antibiotic.

Most digestive problems go away once a person stops taking the antibiotic.

Persons with digestive side effects, such as bloody diarrhea, severe abdominal pain, or uncontrollable vomiting, should stop taking their antibiotics and immediately contact a doctor.

Learn more about other common digestive disorders here.

Fungal infection

Antibiotics are drugs that kill harmful bacteria. However, they sometimes kill the good bacteria that protect people from fungal infections and upset the natural balance of the body’s natural flora.

As a result of this imbalance, taking antibiotics may lead to a fungal (candida) infection of the mouth, digestive tract, or vagina.

Candidiasis in the mouth and throat is also called thrush.

Symptoms of thrush may include:

white patches on the throat, cheeks, roof of the mouth, or tongue
pain while eating or swallowing
bleeding with tooth brushing

Doctors usually prescribe antifungal medications such as nystatin to treat fungal infections.

Learn more about the gut microbiota here.

UTI antibiotics and yeast infections

Treating a UTI with antibiotics can sometimes lead to a vaginal yeast infection.

Symptoms of a vaginal yeast infection may include:

vaginal itchiness, swelling, and soreness
pain and a burning sensation during intercourse and when peeing
abdominal or pelvic pain
blood in the urine
white-to-grey lumpy vaginal discharge
fever and chills

Doctors often prescribe the antifungal drug fluconazole to treat yeast infections caused by UTI antibiotics.

Learn more about the safety of having sex and a UTI.

Drug interactions

Certain may interact with a person’s other medicines or supplements.

The symptoms of drug interactions range from mild to life threatening. Some common warning signs after taking the medication include:

feeling nauseous
feeling either very tired or very energetic

According to the Food and Drug Administration (FDA), drug interactions may make an antibiotic less effective or increase the action of a particular drug.

It is generally a good idea to avoid alcohol while taking antibiotics. Drinking alcohol while on certain antibiotics can decrease the effectiveness and increase the chance of antibiotic side effects.

Antibiotics that may interact with alcohol include:

doxycycline
erythromycin
metronidazole
tinidazole
isoniazid

To help avoid antibiotic drug interactions, people should always review newly prescribed medications with their doctor or pharmacist. Patient education inserts also list any drugs that might interact with the prescribed antibiotic.

Learn more about alcohol and antibiotics here.

Photosensitivity

Certain medications, including antibiotics, make the skin more sensitive to sunlight. This is a condition called photosensitivity.

Photosensitivity symptoms include:

discoloration of the skin, similar to the effects of sunburn
inflammation
itching
blisters that resemble hives
dry patches

Some antibiotics that may cause photosensitivity include ciprofloxacin, doxycycline, and levofloxacin.

While taking antibiotics that may cause photosensitivity, people should:

avoid prolonged periods of light exposure, especially between the hours of 10.00 a.m.–4.00 p.m.
use a broad sunscreen with an SPF value of 15 or above when outdoors, even on cloudy days
wear protective clothing such as broad-brimmed hats, long-sleeved shirts, pants, and sunglasses to limit sun exposure

Anyone who experiences extreme sensitivity to the sun while taking antibiotics should talk with a doctor.

Learn about sunburn on dark skin here.

Staining

Research suggests that people who take tetracycline develop stains on their skin, nails, teeth, and bones. Doctors consider this a known but rare side effect of prolonged tetracycline use.

Teeth staining is irreversible in adults because their teeth do not regrow or change. However, as bones remodel themselves continuously, it is possible to reverse the staining.

A person should talk with a doctor about switching medications if taking antibiotics causes tooth discoloration or staining.

Learn more about stained teeth here.

Some of the more serious side effects associated with antibiotics include:

Anaphylaxis

In rare cases, antibiotics can cause an extremely severe allergic reaction known as anaphylaxis.

Signs of anaphylaxis include:

a rapid heartbeat, when a person’s resting heartbeat is greater than 60–100 beats per minute
hives or a red, itchy rash
feelings of uneasiness and agitation
tingling sensations and dizziness
swelling of the face, mouth, and throat
rapid swelling of the lips or under the skin
severe wheezing, coughing, or trouble breathing
low blood pressure
fainting
seizures

Anaphylaxis can be fatal without immediate emergency care. If people suspect anaphylaxis, they should dial the emergency services or go to the emergency room right away.

Learn more about the symptoms of anaphylactic shock here.

Clostridium difficile-induced colitis

C. difficile is a type of bacteria that can infect the large intestine and cause C. difficile-induced colitis, which causes intestinal inflammation and severe diarrhea.

Doctors find C-difficile-induced colitis challenging to treat because the bacterium is resistant to most antibiotics available.

Severe, chronic, or untreated cases of C-difficile-induced colitis can lead to death.

Anyone who has any concerns about developing an antimicrobial-resistant infection when taking antibiotics should talk with a doctor.

Learn more about antimicrobial resistance here.

Antibiotic resistance

Antibiotic resistance happens when germs develop the ability to overcome the antibiotic’s ability to kill them. That means the germs continue to grow.

Some infections caused by an antibiotic-resistant strain of bacteria do not respond to any available antibiotics. Antibacterial-resistant infections can be severe and potentially life threatening.

According to the Centers for Disease Control and Prevention (CDC), at least 2.8 million people in the United States contract antibiotic-resistant bacteria or fungi each year, and more than 35,000 people die as a result.

There are certain ways to help reduce the risk of developing antibiotic resistance, including:

helping prevent the spread of infections by getting appropriate vaccinations, proper hand-washing, and staying home when sick
following safe food preparation steps
taking antibiotics exactly as the doctor prescribes if you need them
talking with your doctor or pharmacist about ways to feel better if the infection does not require antibiotics
never taking antibiotics that a doctor has prescribed for someone else
never using leftover antibiotics or saving extra antibiotics
returning unused antibiotics to a pharmacy or putting them in the trash

Learn how to dispose of medications safely here.

Kidney disease

According to the National Kidney Foundation, the kidneys clear many antibiotic medications.

When the kidneys are not working correctly, these medications can build up and lead to further kidney damage.

Doctors often check kidney function blood tests before prescribing antibiotics for individuals with kidney disease.

Learn about kidney failure here.

According to a study, long term side effects of antibiotics in adult females have links to changes in the gut microbiota. This change has links to risks of various chronic diseases, such as cardiovascular disease and certain types of cancer.

This study also states that the length of antibiotic exposure may be a risk factor for premature death.

Additional research also found that prolonged exposure to antibiotic therapy has associations with an increased risk of gastrointestinal issues in premature babies, late-onset sepsis, or death among very low birth weight infants.

Learn more about sepsis in babies here.

A doctor will usually confirm whether a person has a sensitivity or allergy to a particular antibiotic and will likely prescribe an alternative.

If a doctor prescribes an antibiotic, but the symptoms persist after a few days of taking it, a person should also consult a doctor.

However, anyone who has a severe side effect or allergic reaction while taking antibiotics should immediately stop taking the medications and seek medical attention.

Antibiotics are prescription medications that kill or prevent bacteria from growing. Doctors prescribe antibiotics to treat bacterial infections, such as strep throat or skin infections.

Antibiotics commonly produce side effects that range from mild to severe, so a person should only take them when a doctor deems them necessary.

People should report any antibiotic side effects to their doctor or healthcare professional.

8 side effects of taking antibiotics that even doctors rarely talk about / AdMe

The most common side effects of taking antibiotics are nausea and diarrhea. Almost everyone knows about them – either from doctors or from their own experience. But American scientists have found that at least 20% of people who have taken antibiotics at least once in their lives experienced other side effects from drugs. It is about them that we will tell in this article.

We are in ADME We want to emphasize that different people may experience different side effects from taking medications. You can always find a complete list of them in the instructions for the drug.

1. Sun sensitivity

©Depositphotos, ©Depositphotos

Some antibiotics (tetracyclines, fluoroquinolones and sulfones) can affect how your skin reacts to UV radiation. Too much sunlight while taking medication can increase the chance of burning or severe skin flaking.

These same antibiotics can cause a rash even if the person has been in the sun for only 15 minutes.

What to do?

It is better not to be in the sun between 10 a.m. and 2 p.m., use sunscreen and hide your skin under clothing.

2. Headache or dizziness

Headache and dizziness are two other common complaints of people who take antibiotics. But usually they disappear after the completion of the course of treatment.

What to do?

If your head hurts a little, you can take painkillers. If the pain is unbearable, then it is better to consult a doctor. Most likely, he will change the antibiotic.

3. Fever

Fever can be a side effect of more than just antibiotics. If it manifested itself against their background, then, , you may have an allergic reaction to the medicine, which is accompanied by a fever . Otherwise, it is a separate and unpleasant side effect.

Fever can occur with almost any antibiotic, but is most commonly associated with beta-lactams, cephalexin, minocycline, and sulfonamide.

What to do?

If you get a fever while taking an antibiotic, it will most likely go away on its own pretty soon. But if the fever is strong and lasts too long, you need to try to bring it down and contact your doctor to change the antibiotic.

4. Fungal infection

Antibiotics change the bacterial environment of our bodies, making us vulnerable to fungi. They can occur in the mouth (stomatitis), on the skin or under the nails.

What to do?

If your doctor has prescribed you a long course of treatment, it is better to start taking antifungal drugs immediately along with antibiotics.

5. Heart problems

This is rare, but antibiotics can cause heart problems. They usually lead to arrhythmia or low blood pressure.

These side effects are most commonly caused by erythromycin and some fluoroquinolones such as ciprofloxacin.

What to do?

See a doctor to change the antibiotic.

6. Teeth staining

©Depositphotos

Tetracycline antibiotics may cause staining or discoloration of teeth in children under 8 years of age . And if you take them during pregnancy, then there is a high chance that the newborn baby will have problems with tooth enamel.

What to do?

Recently, scientists have found that the more modern antibiotic doxycycline (from the tetracycline group) does not bind to calcium so strongly that it does not cause tooth staining. Therefore, it can be taken without fear of such consequences. But, of course, only on doctor’s orders.

7. Allergy

One of the most dangerous reactions of the body to antibiotics is an allergy. In this case, a person may develop an itchy rash, swelling of the eyelids, lips, tongue and even throat, leading to anaphylaxis . Sometimes in such situations, a dose of adrenaline received in an ambulance can save the patient.

But an allergic reaction to a single antibiotic does not mean that you should not take them at all.

What to do?

Be sure to tell your doctor if you have any allergies and take other antibiotics. Also, be careful when you start taking a new medicine that you have never tried before. At the first symptoms of an allergy, you should consult a doctor or an ambulance.

8. Unwanted pregnancy

©Depositphotos

If you take the antibiotic rifamycin and oral contraceptives at the same time, the effectiveness of the latter decreases. As a result, the chance of an unwanted pregnancy increases. Other antibiotics reduce the effect of oral contraceptives to a lesser extent.

What to do?

Use an additional barrier method of contraception while taking antibiotics and for a week after completing the course. More information about the terms of additional protection is written in the instructions for oral contraceptives.

If you experience any of the side effects while taking antibiotics, do not self-medicate, do not ignore feeling unwell. Be sure to go to the doctor and consult.

Were you aware of any of these side effects of medications?

Depositphotos Preview Photo

Bright Side/8 Antibiotic Side Effects Even Doctors Rarely Tell About

HPV, Antibiotic Allergy, Gastrointestinal Problems

Content

1 HPV, antibiotic allergy, gastrointestinal problems
- 1. 1 Dangerous side effects
- 1.2 HPV
- 1.3 Antibiotic allergy
- 1 .4 Problems with the gastrointestinal tract
- 1.5 Related videos:
- 1.6 Q&A:
  - - 1.6.0.1 What side effects can the HPV vaccine have?
    - 1.6.0.2 What types of allergies to antibiotics are there?
    - 1.6.0.3 Can antibiotics affect the gastrointestinal tract?
    - 1.6.0.4 What manifestations of dysbacteriosis can occur after taking antibiotics?
    - 1.6.0.5 How do I know if I’m allergic to antibiotics?
    - 1.6.0.6 How common are serious HPV vaccine side effects?
    - 1.6.0.7 How long does dysbiosis last after taking antibiotics?

This article will talk about how HPV, antibiotic allergies and gastrointestinal problems can be related. You will learn about the characteristics of the manifestation of each of these conditions and tips for their prevention and treatment.

Sometimes the cure can be much more dangerous than the disease itself, especially for those who are susceptible to side effects. Some, such as HPV, antibiotic allergies, or gastrointestinal problems, are so severe that they can even be life-threatening.

HPV (Human Papilloma Viruses) are ubiquitous throughout the world, and more and more people have to seek help for side effects from their treatment. Allergies to antibiotics can also be very dangerous, and many people don’t realize this until they encounter the problem.

Gastrointestinal problems can present with many different symptoms, and many of them can be very painful and uncomfortable. If you experience any discomfort in the area of the stomach or intestines, it is always worth contacting a specialist in order to avoid difficulties in the future.

Dangerous side effects

HPV (human papillomavirus) is the most common sexually transmitted infection. In this case, women may be at risk of developing cervical cancer, and men – cancer of the head and neck of the penis. Also, the infection can cause the formation of warts, which can be dangerous to human health.

Allergy to antibiotics can occur in anyone, regardless of age and health. This condition can cause severe skin irritation, swelling, itching, and difficulty breathing. Therefore, in case of allergy to antibiotics, you should immediately stop taking them and consult a doctor.

Gastrointestinal problems can occur when a person has an unhealthy diet, certain medications, or chronic diseases. Symptoms can range from heartburn and gas to severe pain and bleeding. It is necessary to monitor your diet and consult a doctor if there are deviations in the work of the gastrointestinal tract.

In the case of HPV, it is necessary to use barrier contraception, regularly visit a gynecologist and take tests.
When taking antibiotics, you must follow the dosage and regularly undergo medical examinations.
To maintain a healthy gastrointestinal tract, include more vegetables, fruits, and healthy protein foods in your diet.

Side effect
Symptoms
Treatment

Features of HPV infection	Wart formation, risk of cancer	Barrier contraception, regular gynecological examination
Allergy to antibiotics	Skin irritation, swelling, itching, breathing difficulties 9023 0	Stop taking antibiotics and see a doctor
Problems with the gastrointestinal tract	Pain, heartburn, gas, bleeding	Follow the correct dosage of medications, control your diet, see a doctor

HPV

Human papillomavirus (HPV) is a sexually transmitted virus that can cause cervical cancer, other genital cancers, and cancer of the throat and mouth.

Some types of HPV are high risk and can cause cancer in 90% of cases. Vaccination against HPV can prevent the development of cervical cancer and other types of cancer associated with the virus.

HPV symptoms are absent in most cases and the person may not know they are infected with the virus. However, in women, HPV may be detected during a Pap test or colposcopy.

In addition to cancer, HPV can also cause warts and flat warts on the skin and mucous membranes of the genitals, mouth and throat.

HPV prevention tips:

get vaccinated;
avoid sexual intercourse or engage in monogamous relationships;
use condoms;
have regular check-ups with a gynecologist and monitor the health of your genitals.

Allergy to antibiotics

Allergy to antibiotics is one of the most common side effects of antibiotics. The possibility of developing allergic reactions to antibiotics exists in every fifth patient.

Symptoms of an allergic reaction to antibiotics can range from mild skin rashes and itching to anaphylactic shock. At the first sign of an allergy, you should immediately consult a doctor.

To prevent the development of an allergy to antibiotics, it is necessary to clarify the history of the patient’s drug use before prescribing antibiotics. Often, patients who have previously experienced an allergic reaction to certain types of antibiotics may be allergic to other antibiotics.

If you have an allergic reaction to an antibiotic, your doctor may prescribe a different antibiotic. With severe manifestations of allergies, the use of antihistamines and glucocorticosteroids may be required.

Most common antibiotics causing allergies

Antibiotic name
Probability of developing allergies

902 23

Penicillins	1% to 10%
Cephalosporins	1% to 5%
Sulfonamides	1% to 4%
Tetracyclines	1% to 3%

An allergic reaction to antibiotics can be dangerous and even fatal, so it is important to carefully monitor patients when using antibacterial drugs and strictly follow the doctor’s recommendations.

Problems with the gastrointestinal tract

The gastrointestinal tract plays an important role in our body: it performs the function of digestion of food, which then enters the cells as a source of energy and nutrients. However, the gastrointestinal tract can be affected by many factors that can cause it to malfunction.

One of the most common problems with the gastrointestinal tract is gastritis, an inflammation of the stomach lining. This can occur due to smoking, drinking alcohol, excessive caffeine intake, and also due to breakdowns in the stomach’s defense mechanism.

Certain types of medicines may also cause adverse effects on the gastrointestinal tract. Prolonged use of antibiotics can cause dysbacteriosis – a violation of the normal intestinal microflora, which leads to a violation of digestion and the immune system.

Prevention of gastrointestinal problems includes:
Proper nutrition: Avoid excess fatty, very sweet, savory and salty foods. Try to eat small meals, but often. Eat slowly, chew your food well.
Quit bad habits: Stress and nervousness often lead to gastrointestinal problems, so it is recommended to avoid stressful situations, avoid drinking alcohol, smoking, and engage in outdoor activities such as yoga and meditation.
Good sleep: A stable sleep schedule will help the body to maintain the proper functioning of all organs.

Q&A:

What side effects can the HPV vaccine have?

The main side effects of the HPV vaccine are pain and redness at the injection site, headache, nausea and fever. Very rarely, serious allergic reactions can occur, but such cases are extremely rare. As with any vaccine, dizziness or loss of consciousness may occur, but these are very rare and are usually due to other factors.

What types of allergies to antibiotics are there?

There are several different types of allergy to antibiotics, including the common allergy of skin rash, pruritus and angioedema, anaphylactic shock, urticaria, and allergic contact dermatitis. The types of allergies to antibiotics depend on which antibiotic was used and how the body reacts to it.

Can antibiotics affect the gastrointestinal tract?

Yes, antibiotics can affect the gastrointestinal tract, causing dysbiosis and other digestive problems. Antibiotics destroy both pathogenic and beneficial bacteria in the intestines, which can lead to disruption of the normal microflora. In addition, some people may be allergic to certain antibiotics and develop allergic reactions such as diarrhea, nausea, and vomiting.

What manifestations of dysbacteriosis can occur after taking antibiotics?

After taking antibiotics, dysbacteriosis can occur, which is manifested by diarrhea, heartburn, constipation, gas formation and other digestive problems. This is because antibiotics destroy both pathogenic and beneficial bacteria in the intestines, which can lead to disruption of the normal microflora. This can cause various digestive problems and even lead to the development of other diseases.

How do I know if I’m allergic to antibiotics?

Signs of an allergy to antibiotics may include rash, itching, swelling and redness of the skin, hives, nausea, vomiting, and difficulty breathing. If you notice any of these symptoms while taking antibiotics, you should see your doctor for diagnosis and appropriate action.

How common are serious HPV vaccine side effects?

Serious side effects from the HPV vaccine are very rare and occur in an extremely small percentage of cases – less than 1%. However, as with any vaccine, there may be some minor problems, such as pain and redness at the injection site, headache, nausea, and fever. In any case, all side effects of the HPV vaccine should be described in the instructions for use.