G. Richard Bruno Wallace A. Carter

Common. .Adverse.. Effe.ct.s...of .Antimicrobial... Agents Specific.. .Agents...and.. .Adverse.. Effects ..a,t..Zh,e,ra,pe,ut,ic, .Doses Penicillins/CephaloSPorin,S/b.MLactams








Antimalarial. Drugs


Evaluation. .and Xreatmentof. .Antimicrobial. .Overdose Chapter.. References

Antimicrobial agents are estimated to account for 15 to 30 percent of the world medical drug expenditure.1 Most adverse reactions to antibiotics occur at therapeutic doses. The most common adverse effects of antimicrobial use include hypersensitivity reactions, alterations in body microbial flora, interactions with other drugs, and cutaneous drug reactions. Data from the American Association of Poison Control Centers (AAPCC) suggest that antimicrobial exposures are a frequent source of inquiry to poison control centers but rarely result in life-threatening outcomes. During the 5 years from 1992 through 1996, the AAPCC reported 316,653 exposures, which resulted in significant morbidity in 768 cases (0.24 percent) and 23 fatalities (less than 0.01 percent). Emergency physicians must be familiar with the common adverse effects of antimicrobial agents at therapeutic doses (Ta.ble 180-,1.), any significant interactions with other drugs, effects on pregnancy (Table 18.0-2.), and the clinical presentation and management of acute antimicrobial overdose. Hypersensitivity reactions account for the highest morbidity and mortality rates related to the use of antimicrobial agents. Most patients who present after antimicrobial overdose will be asymptomatic. Observation and screening for coingestants are adequate before medical clearance in most cases. The poison control center should be contacted to assist in patient management and to aid in accurate statistical tracking of toxin exposures.

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TABLE 180-1 Adverse Effects of Common Antimicrobial Agents at Therapeutic Doses

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