TABLE 2.
Toxica and immunotoxic adverse events mediated by antibacterial agents
| Side effect (frequency) | Mechanism |
|---|---|
| Neutropenia and agranulocytosis | |
| Chloramphenicol (1/20,000; 50% mortality) | Toxicity (nitrosoderivative, dehydrochloramphenicol) |
| β-Lactams (5–15%) | Toxicity |
| Semisynthetic penicillins, high dose, long term Methicillin (8%) Cephalosporins (0.1%) | (in vitro: cephalosporins, imipenem > penicillins > monobactams; in vivo: penicillins > cephalosporins) Antibodies Individual susceptibility |
| Sulfonamides (0.1%) | Toxicity plus antibodies (phagocyte-mediated drug alteration) plus genetic defect (detoxifying enzymes) |
| Co-trimoxazole (10%) | |
| Dapsone (0.01%) | |
| Maloprim (pyrimethamine + dapsone) (0.5%) | |
| Isoniazid, clindamycin, PAS, rifampin, ethambutol, aminoglycosides, ciprofloxacin (in vitro + TNF) (0.1 to 0.5%) | Toxicity for progenitor cells |
| Autoimmune diseases | |
| Systemic lupus erythematosus antinuclear antibodies: isoniazid (20%) | Immune complexes (PMN-mediated oxidation of isoniazid) |
| Lupus syndromes: sulfonamides, nitrofurantoin | |
| Autoimmune anemia, thrombocytopenia; penicillins, cyclines, cephalosporins, streptomycin, sulfonamides, nitrofurantoin, etc. | Antibodies |
| Hypersensitivity | |
| Anaphylaxis: penicillin G (2%) | Allergy, pseudoallergy |
| Immediate hypersensitivity: penicillin G (0.7–10%), clindamycin (10%), co-trimoxazole (6%), gentamicin, streptomycin, isoniazid (2%), amikacin, chloramphenicol, p-aminosalicylic acid, rifampin, trimethoprim (0.5–2%), erythromycin, tetracycline, vancomycin (0.1–0.5%) (streptomycin: peripheral PMN) | Drug metabolism by phagocytes |
a
Note that only adverse effects related to the immune system are presented here.