Antibiotic Drugs

Penicillins: Organs and Systems: Immunologic

Anaphylactic shock can occur, even after oral administration of penicillin and skin testing. However, anaphylactic shock is less common after oral than parenteral administration. In one study the incidence of anaphylactic shock was 0.04% of all patients treated with penicillin. It is also low in patients receiving long-term benzathine penicillin (1.2 million units every 4 weeks).

Penicillins: Organs and Systems: Skin

Skin reactions are the commonest adverse effects of therapeutically administered penicillins. Penicillin-contaminated milk or meat can cause itching or generalized skin reactions or even anaphylaxis. The overall annual incidence of severe erythema multi-forme (toxic epidermal necrolysis and Stevens-Johnson syndrome) is about one case per million, antibiotics being involved in 30-40%. The clinical differentiation between these syndromes can be difficult.

Penicillins: Organs and Systems: Liver

Penicillin-induced hepatotoxicity may not be as uncommon as has been thought. There have been three reviews. The first was a comparison of the assessment of drug-induced liver injury obtained by two different methods, the Council for International Organizations of Medical Sciences (CIOMS) scale and the Maria & Victorino (M&V) clinical scale. Three independent experts evaluated 215 cases of hepatotoxicity reported using a structured reporting form.

Penicillins: Organs and Systems: Hematologic

Since the days when chloramphenicol was more commonly used, it has been recognized that many antimicrobial drug are associated with severe blood dyscrasias, such as aplastic anemia, neutropenia, agranulocytosis, throm-bocytopenia, and hemolytic anemia. Information on this association has come predominantly from case series and hospital surveys (38^. Some evidence can be extracted from population-based studies that have focused on aplastic anemia and agranulocytosis and their association with many drugs, including antimicrobial drugs. The incidence rates of blood dyscrasias in the general population have been estimated in a cohort study with a nested case-control analysis, using data from a General Practice Research Database in Spain.


The anthracyclines are composed of a tetracyclic ring with adjacent quinone-hydroquinone moieties and a short side chain with a carbonyl group at C-13; an aminosugar is attached by a glycosidic bond to the C-7 of the tetracyclic ring. Doxorubicin (DOX) and daunorubicin (DNR) differ in the side chain terminus (-CH2OH or-CH3, respectively).

Nafcillin Sodium – Penicillin Antibiotic

Nafcillin shares the uses of other parenteral penicillinase-resistant penicillins (e.g., oxacillin) and generally is used only in the treatment of infections caused by, or suspected of being caused by, susceptible penicillinase-producing staphylococci. For specific information on the uses of nafcillin, see Uses in the Penicillinase-Resistant Penicillins General Statement 8:12.16.12. Nafcillin sodium is administered by IM injection or by IV injection or infusion. Although nafcillin also has been administered orally, the drug is poorly absorbed from the GI tract and an oral preparation of the drug is no longer commercially available in the US.

Meropenem (Merrem I.V.)

Meropenem is a synthetic carbapenem antibiotic. Unlike imipenem, meropenem has a methyl group at position 1 of the 5-membered ring, which confers stability against hydrolysis by dehydropeptidase 1 (DHP 1) present on the brush border of proximal renal tubular cells and therefore does not require concomitant administration with a DHP-1 inhibitor such as cilastatin.

Loracarbef (Lorabid Capsules 200, 400 mg)

Carbacephems are b-lactam antibiotics structurally and pharmacologically related to cephalosporins; however, carbacephems contain a methylene group instead of sulfur in the dihydrothiazine ring of the cephalosporin nucleus, resulting in a tetrahydropyridine ring. This structural modification does not affect microbiologic activity, but substantially improves stability in aqueous solution and in serum, plasma, and other body fluids. Loracarbef is the carba analog of cefaclor, a second generation cephalosporin. SumMon® (see Users Guide).

Gentamicin Sulfate (Garamycin)

Gentamicin sulfate is administered by IM injection or IV infusion. The drug also has been administered without preservatives intrathecally or intraventricularly to supplement IM or IV administration in the treatment of CNS infections.