β-lactams | | | |
Penicillins | | | |
|
|
Uncommon: gastrointestinal effects—vomiting Nausea, diarrhea, bloating, indigestion, abdominal pain, and loss of appetite (0.1% to 1% of patients)23
|
Fatal anaphylaxis (0.0015% to 0.002%)3 Very rare: drug-induced anemia, renal inflammation, and serum sickness2,23 Clostridium difficile infection24
|
|
Rash (5% to 10%)3 Anaphylaxis Common: allergy3
|
Common: gastrointestinal effects25 Diarrhea (about 2%)25 Candidiasis (OR = 7.77, NNH = 27)25,26 Diaper rash (50%)27,28 Skin rash in patients with mononucleosis29,30
|
|
| Same as for amoxicillin, plus the following:
| Same as for amoxicillin, plus the following:
Common: gastrointestinal effects Headache32 Diarrhea (OR = 3.30, NNH = 10)25,33 Candidiasis (OR = 7.77, NNH = 20)25,26
| Same as for amoxicillin, plus the following:
|
|
Very rare: rash Very rare: hives Very rare: anaphylaxis2
|
|
|
Cephalosporins | | | |
|
|
Common: gastrointestinal effects seen in more cases with third generation vs first generation (2.5% for first; 4.5% to 15% for third) Common: headaches, neurologic symptoms (dizziness, paresthesias) (1% to 2%) Prolonged prothrombin time (4%)
|
Serum sickness–like syndrome (0.024% to 0.2%)2 Thrombophlebitis (1% to 2%) Uncommon: hematologic toxicities (< 1%) C difficile infection (third generation; RR = 15.33)10
|
Non–β-lactams | | | |
Fosfomycin37,38 |
Rash (1.4%) Rare: angioedema
|
|
Lymphadenopathy (< 1%), aplastic anemia, asthma (exacerbation), cholestatic jaundice, hepatic necrosis, and toxic megacolon38
|
Lincosamides | | | |
|
|
Very common: gastrointestinal effects—diarrhea most common (12% to 14%)39 Dermatologic effects (red skin, rash)
|
|
Linezolid40 |
|
|
Myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia; some irreversible. Monitor CBC weekly during treatment) C difficile infection Peripheral and optic neuropathy (some irreversible) Hypertension, convulsions, lactic acidosis Serotonin syndrome (weak MAO inhibitor) when taking MAO inhibitors or serotonergic drugs, especially SSRIs or SNRIs, but also other drugs
|
Macrolides | | |
|
|
|
Gastrointestinal effects: stomach pain (NNT = 17), diarrhea (NNT = 19), nausea (NNT = 19), and vomiting (NNT = 45)41
|
Irregular heart rhythms (irreversible; especially with underlying QT prolongation)42 Hearing loss (irreversible)41 Rare: cardiovascular deaths (azithromycin)43 Drug-induced mixed hepatitis (idiosyncratic)32 C difficile infection: erythromycin (RR = 10.03), clarithromycin (RR = 7.49), and azithromycin (RR = 2.88)
|
Methenamine44 |
|
Gastrointestinal effects (3.5%) Urologic effects with large doses (eg, dysuria, changes in frequency, hematuria, albuminuria)
|
|
Metronidazole45 |
|
|
Carcinogenic in rats and mice Seizures (with prolonged use; reversible) Peripheral neuropathy (with prolonged use; irreversible) Pancytopenia (reversible with discontinuation) Reproductive system effects (dyspareunia, pelvic pressure, proctitis, vaginal dryness, decreased libido; reversible) Urologic effects (eg, dysuria, polyuria, incontinence, darkened urine [1 in 100 000]; reversible) Others: arthralgias, nasal congestion (reversible)
|
Nitrofurantoin |
|
Gastrointestinal effects such as vomiting, diarrhea, and stomach pain46 Nausea (8%), headache (6%), and flatulence (1.5%)46
|
Pulmonary toxicity: chronic pulmonary reactions; diffuse interstitial pneumonitis, pulmonary fibrosis, or both (irreversible)46 Drug-induced liver injury32 Aplastic anemia46 Peripheral neuropathy (irreversible)46 Hemolytic anemia46
|
Quinolones | | | |
|
Rare: allergic reactions3 Flushing, itching, and angioedema2
|
Gastrointestinal effects47 Headaches12,47 Arthralgias and myalgias47 Neuropathies (numbness, tingling)47 Confusion47
|
Tendonitis and Achilles tendon rupture, especially in those >60 y or with current corticosteroid use12,47,48 Increased risk of abdominal aorta rupture12,49 Persistent peripheral neuropathy (irreversible)12,47 Dysglycemia, hypoglycemic coma47 Neurologic or psychiatric disturbances50 Exacerbation of myasthenia gravis C difficile infection10: levofloxacin (RR = 1.93), ciprofloxacin (RR = 8.03), and moxifloxacin (RR = 1.2) Rare: retinal detachment (4 per 10 000)51 Drug-induced mixed hepatitis52 Moxifloxacin: fulminant hepatitis and toxic epidermal necrolysis52
|
Sulfonamides and related drugs | | | |
|
|
|
|
|
|
|
Hypersensitivity reactions (0.09%): includes anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, serum sickness–like syndrome, lupuslike syndrome, pneumonitis, hepatitis, interstitial nephritis, vasculitis, and pancytopenia55 Rare: drug-induced mixed hepatitis32 C difficile infection (RR = 3.32)10,55
|
Tetracyclines | | |
Might cause permanent discoloration of the teeth during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 y)56 Can cause fetal harm when administered to a pregnant woman56 C difficile-associated diarrhea56
|
|
|
Gastrointestinal effects (up to 20%)57 Phototoxicity (3% for 100 mg/d, 20% for 150 mg/d, 42% for 200 mg/d, 7.5% overall incidence)58 Abnormal weight gain (23% in Q fever endocarditis)58 Esophagitis59 Esophageal ulceration59
|
Hypersensitivity reaction57 Serum sickness–like reaction57 C difficile infection (RR = 7.23)10
|
|
|
Gastrointestinal effects (25%)59 Neurologic effects (vertigo, ataxia, dizziness, weakness)57
|
Hypersensitivity reaction57 Serum sickness–like reaction57 Drug-induced lupus57 Pneumonitis57 Skin hyperpigmentation (irreversible)58
|
|
|
|
Hypersensitivity reaction57 Serum sickness–like reaction57 C difficile (RR = 14.04)10
|
Vancomycin60 |
|
Nausea (17%), abdominal pain (15%), vomiting (9%), diarrhea (9%), flatulence (8%) Fatigue (5%) Back pain (6%) Headache (7%)
|
|
Azoles | | | |
|
|
Gastrointestinal effects (up to 7%) Neurologic effects (up to 3%; eg, dizziness, headache, dysgeusia)
|
Severe or fatal hepatic injury (sometimes irreversible) Anaphylaxis Others: asthenia, seizures, metabolic disturbances (lipid levels), myalgia, insomnia, severe skin rashes, alopecia (more frequent in persons with HIV infection)
|
|
|
Gastrointestinal effects (up to 11%) Systemic effects (up to 9%; eg, fatigue, fever, malaise) Neurologic effects (up to 10%; eg, dizziness, headache, somnolence, abnormal dreams) Decreased libido, impotence (1%) Cardiac or renal effects (up to 2%; eg, hypertension, hypokalemia) Elevated liver enzyme levels (4%) Nasal, sinus, and respiratory symptoms (up to 9%)
|
Hepatotoxicity: fatal liver failure Hypersensitivity reactions Transient or permanent hearing loss (irreversible) Others: cytopenias, neuropathies, visual disturbances, dysgeusia, pulmonary edema, severe skin rashes (eg, Stevens-Johnson syndrome, vasculitis), edema
|
|
|
|
|