Important Side Effects and Toxicities (Antibiotics - Lecture 8)
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- เผยแพร่เมื่อ 22 พ.ค. 2024
- A lecture covering the major side effects of antibiotics, including allergic reactions, diarrhea, C.diff colitis, QT prolongation, and interactions with warfarin. It also includes discussion of cross reactivity between penicillins and cephalosporins, as well as how to use serum drug levels to titrate vancomycin and aminoglycosides.
"...when it comes to being sued...common perception usually carries greater weight than scientific truth." (at around 8:53). Well said sir.
Thank you so much for these incredibly useful lectures! Such a helpful review!
This lecture gives a basic, but very helpful understanding the side effects from antibiotics.
Excellent as always. Thank you!
Thank you very much for these wonderful lectures. I noticed a possible correction: with drug serum monitoring, trough correlates better with the frequency not dose. And peak correlates with dose. So if somebody's vanc trough was low, you would look to increase the the frequency from q24 to q18 for example with the same dose.
drarunrx, thanks for watching and clearly listening closely! You are correct in the sense that usually if a serum trough level was too low or too high, but the serum peak level is adequate, you would adjust the frequency (though this also has a smaller impact on peak level). And if the trough level was fine, but the serum peak was not, you would adjust the dose (which also has an impact on trough level). So in order to change one of the two end-results (peak or trough), but keep the other the same, one would need to change both the dose and frequency in a somewhat complicated manner requiring several calculations. Since patients' renal functions constantly change, measured drugs levels have some range of lab error, and these pharmacokinetic principles are just theoretical approximations anyway, in practice, most clinicians and pharmacists don't necessarily change both dose and frequency, but just change one for simplicity (consistent with what you suggest). This is typically how aminoglycosides get redosed. With an aminoglycoside, if the peak was fine, but the trough was too low, if the clinician/pharmacist increased the dose and left frequency unchanged, while the trough may now be fine, he/she would risk the patient's peak level moving into the toxic range. So for AGs, if the trough is too low, one should increase the frequency.
Vancomycin is different. With vancomycin, we don't usually care too much about the peak drug level (which is why it is rarely measured). So for a subtherapeutic vanc trough level, we can either increase the frequency or the dose. While increasing the frequency probably feels more elegant and is more consistent with how we dose other drugs, from a practical standpoint, it is often easier from an administration standpoint to change the dose. That's because unusual dosing intervals (q18 hrs, q 36 hrs, etc...) are incrementally more difficult for people to keep track of, and to be sure that patients are getting the drugs at the appropriate times.
Bottom line: with vanc, the approach to redosing is sort of a matter of preference. Do you prefer to do something more elegant but requires slightly more attention on the part of nursing and pharmacy? Or doing something that will be easier for ward staff, but would make your pharmacology professor scowl? From a practical standpoint, either approach is perfectly acceptable - though this applies just to vancomycin, not necessarily to any other drug.
And if all that wasn't enough to read about, optimal vancomycin dosing strategies is an area of ongoing controversy and investigation. You can look at this article: PubMed ID 23851909, for discussion of a new "area under the curve" strategy to vanc dosing, which to my knowledge, is not yet applied clinically.
Eric's Medical Lectures Thank you for your quick and detailed response. I agree with your explanation. The only caveat with increasing vanc dose to bring up the trough is to be conservative and increase by small increments. Although we do not usually measure peak it certainly can cross into the range of toxicity if dose gets bumped up too much in an effort to bring up the trough.
drarunrx I completely agree with being gradual with increases in vanc dose, and if the trough was very low (i.e.
Thank You
Thank you
I have brucellosis and the doctor gave me antibiotics for 4 weeks such as argumentin and broxocyclin and im expriencing itching and tongue problem what should I do ???
Hassan Abdikadir I'm sorry, but you need to discuss the symptoms with your doctor. I am unable to offer specific medical advice here.
Around the 13 minute mark, you discuss the interference of antibiotic therapy with warfarin. First you state that concurrent antibiotics therapy leads to an over-anticoagulation, so a prolongation of the INR. Antibiotic therapy causes a disruption of normal flora that produces vitamin K. You then state that this antagonizes warfarin effect.
I think you mean that vitamin K antagonizes warfarin and that antibiotic therapy decreases vitamin K production, thereby increasing the anticoagulation effect. Did I understand this correctly?
By the way, thank you very much for these lectures. They provide a very nice overview about this difficult topic.
i would like to if i dont get any sign of anafylactic shock in 2 hours after taking the antibiotics , should i be worried that i may still get it ?
We can't give specific, individualized medical advice here. However, allergic reactions to medications can be delayed by a day or more (although that would be unusual in the specific case of anaphylaxis - which is just one of several forms of an allergy-mediated side effect).
eliu1997
I have nausea from antibiotic H pylori tretamemt it's been 9 days I stop but I still have nausea what should I do
You should speak with the physician who prescribed the antibiotic. (I'm sorry, but I am not able to provide specific, individualized medical advice here.)
I have also same problem from antibiotics how long your problem bro
@@RajeshKumar-ig6wb after 12 days its now little better but still feel nausea sometime in day