Adverse Effects of Common Antibiotics
Antibiotics are used to kill bacterial infections; they are not effective against viral infections, such as a cold or the flu, or against fungal infections, like ringworm or vaginal yeast infections. The most common antibiotic classes and drug members are listed in Table , along with the most commonly reported antibiotic side effects.
Adverse Effects of Common Antibiotics and Classes
| ANTIBIOTIC CLASS | ANTIBIOTIC CLASS MEMBERS | MOST COMMON SIDE EFFECTS | ADDITIONAL CLINICAL COMMENTS |
|---|---|---|---|
| Penicillins | penicillin, amoxicillin, amoxicillin-clavulanate, ampicillin, piperacillin-tazobactam, nafcillin, oxacillin | rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions | if bloody stools, anaphylaxis, severe skin reaction, fever occur contact health care provider immediately; ampicillin may cause pseudomembranous colitis |
| Cephalosporins | cephalexin, cefaclor, cefuroxime, ceftibuten, cefdinir, cefixime, ceftriaxone | rash, diarrhea, nausea/vomiting (rare), hypersensitivity (allergic) reactions, serum sickness, vaginal candidiasis | cross-hypersensitivity may occur in patients with documented penicillin allergy |
| Aminoglycosides | gentamicin, tobramycin, amikacin | renal (kidney) toxicity, ototoxicity (hearing loss), dizziness, nausea/vomiting, nystagmus | longer or multiple treatment periods may lead to greater risk for ototoxicity, renal (kidney) toxicity |
| Carbapenems | meropenem, ertapenem, doripenem, imipenem-cilastatin | diarrhea, nausea/vomiting, headache, rash, liver toxicity, eosinophilia (elevated white blood cells) | Hypersensitivity reactions reported with meropenem, imipenem in patients with penicillin allergy |
| Antituberculosis Agents |
rifampin, rifabutin, isoniazid, pyrazinamide, ethambutol, dapsone | diarrhea, nausea/vomiting, anorexia, hemolytic anemia, liver toxicity, headache, peripheral neuropathy, dizziness, reddish-orange body fluids (rifampin, rifabutin only) | sides effects vary among agents, check individually; vitamin B6 (pyridoxine) may be taken to help prevent peripheral neuropathy with isoniazid |
| Glycopeptides | vancomycin, telavancin | vancomycin: red man syndrome (flushing, hypotension, itching); phlebitis; telavancin: taste alteration, nausea/vomiting, headache, dizziness | IV infusion of vancomycin over 60 minutes may prevent red man syndrome |
| Macrolides | erythromycin, azithromycin, clarithromycin | abdominal pain, diarrhea, anorexia, nausea/vomiting, taste alterations (clarithromycin) | high rate of gastrointestinal side effects; do not crush, chew, break, open enteric-coated or delayed-release pill |
| Sulfonamides | trimethoprin-sulfamethoxazole, erythromycin-sulfisoxazole, sulfadiazine | nausea/vomiting, diarrhea, anorexia, abdominal pain, rash, photosensitivity, headache, dizziness | Avoid prolonged sunlight exposure; use sunscreen, wear protective clothing; antibiotic cause of Stevens Johnson Syndrome, Toxic Epidermal Necrolysis |
| Tetracyclines | tetracycline, doxycycline, minocycline | nausea/vomiting, diarrhea, anorexia, abdominal pain, tooth discoloration in children < 8 years, liver toxicity | Avoid prolonged sunlight exposure; use sunscreen, wear protective clothing |
| Quinolones | ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin) | nausea/vomiting, diarrhea, abdominal pain, headache, lethargy, insomnia, photosensitivity (can be severe) | Avoid prolonged sunlight exposure; use sunscreen, wear protective clothing; moxifloxacin associated with higher rates of side effects [shehab]; tendon rupture (rare) more common in age > 60, with corticosteroid use, in kidney, heart, lung translant recipients |
| Lincosamide | clindamycin, lincomycin | pseudomembranous colitis (may be severe), diarrhea, nausea/vomiting, rash, hypersensitivity, jaundice (clindamycin) | if severe diarrhea during treatment or for up to 8 weeks after treatment consult health care provider immediately, may be pseudomembranous colitis (C. dificile); consider use of less toxic agents |
| Miscellaneous | metronidazole | nausea/vomiting, dizziness, headache, vaginal candidiasis, metallic taste | avoid alcohol use during treatment and for up to 3 days after, combined use may lead to cramps, nausea/vomiting, flushing, headache; may discolor urine red-brown |
There are also several side effects that are common to most antibiotics, regardless of class or drug. These side effects may include antibiotic-associated diarrhea, yeast infections, serious allergic skin reactions, and complications from intravenous use of antibiotics.
- Antibiotic-associated diarrhea – Antibiotic-associated diarrhea occurs in patients receiving antibiotics and occurs for no explainable reason. Five to twenty-five percent of patients may develop antibiotic-associated diarrhea. The diarrhea occurs due to eradication of the normal gut flora by the antibiotic and results in an overgrowth of infectious bacteria, such as Clostridium dificile. If the diarrhea is severe, bloody, or is accompanied by stomach cramps of vomiting, a physician should be contacted. The most common antibiotics implicated in antibiotic-associated diarrhea are amoxicillin-clavulanate, ampicillin, and cefixime; however, other antibiotics may lead to this side effect, including cephalosporins, fluoroquinolones, azithromycin, clarithromycin, erythromycin, and tetracycline.2
- Vaginal yeast infections or oral thrush (candida species): Antibiotics may also change the normal flora balance in the vagina, often leading to an overgrowth of fungal species. Candida albicans is a common fungus normally present in small amounts in the vagina, mouth, gastrointestinal tract, and on the skin and does not normally cause disease or symptoms. However, the fungus may take over when there is limited competition from bacteria due to antibiotic treatment.
- Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN): Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious allergic reactions to substances, often drugs, that result in serious skin and mucous membrane disorders. Antibiotics such as sulfonamides, penicillins, cephalosporins, and fluoroquinolones may result in SJS and TEN. SJS and TEN can both cause rash, skin peeling, and sores on the mucous membranes and may be life-threatening.3
- Injection site reactions and phlebitis: A reaction to an antibiotic can occur if the antibiotic is given intravenously in a vein. Injections site reactions and phlebitis (vein inflammation) can occur with intravenously (IV) administered antibiotics. The vein and area with the IV needle may be red, swollen and hot. An infection may or may not be present. Typically, the needle must be removed and reinserted elsewhere to help clear the injection site reaction.
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