Chapter 200

Complications from antimicrobial use are diverse, and the vast majority of adverse effects result from iatrogenic causes rather than intentional overdose. The adverse effects seen from antimicrobials include allergic reactions, drug interactions, secondary or side effects, and, less commonly, toxic effects from acute overdoses. Allergic reactions are common among antibiotics, which may be due to the high frequency of their use, usually in a repeated, interrupted fashion. Many antimicrobial adverse effects are difficult to predict. Some adverse effects are due to a diluent or other chemical constituent in the formulation of a drug. The most common adverse effects of antimicrobial use include hypersensitivity reactions, alterations in body microbial flora, interactions with other drugs, and cutaneous manifestations (e.g., erythema multiforme). Iatrogenic dosing errors commonly involve neonates and infants because of their small weight where mathematic calculations of dose can be inaccurate by several orders of magnitude.

This chapter focuses on the medical considerations of acute antimicrobial overdose (Table 200-1).

Table 200-1 Select Antimicrobial Toxicities and Their Specific Treatments

Antimicrobial exposures are a frequent source of inquiry to poison control centers but rarely result in life-threatening outcomes. During 2008, the American Association of Poison Control Centers received reports of 67,809 exposures to antimicrobials, but significant morbidity was described in only 131 cases (0.01%), and there was only one fatality.1 Poison control center data are gathered passively and this report likely underrepresents the true number of exposed persons.

Most patients who sustain an acute overdose of antimicrobials remain asymptomatic. Observation and screening for coingestants is generally required in most cases. Consultation with a medical toxicologist or the regional poison control center is recommended to assist in patient management and to aid in accurate statistical tracking of toxic exposures. Asymptomatic antimicrobial ingestions require minimal laboratory evaluation. As with all possible overdoses, determining acetaminophen levels and obtaining an ECG is recommended to screen for potentially dangerous coingestants.

Significant ingestion of drugs such as isoniazid, chloroquine, and quinine, however, can result in severe toxicity. The history should ideally include the amount and type of antimicrobial ingested. Patients should also be asked about possible coingestants, and ...

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