ADVERSE DRUG REACTIONS OF ANTIMICROBIAL AGENTS

GUIDED BY:PRESENTED BY:-

Y.VENKATA VYBHAV REDDY Mr. M. RAGHAVENDRA ROLL-10T21R0099 M. Pharm(Ph.d) IV/IV-B. Pharmacy Dept. of. Pharmacology I-SEM(B-sec)

CMR COLLEGE OF PHARMACY

ADVERSE DRUG REACTIONS

An Adverse Drug Reaction (abbreviated ADR) is an expression that describes harm associated with the use of given medications at a normal dosage during normal use.

The study of ADRs is the concern of the field known as PHARMACOVIGILANCE.

ANTI MICROBIAL AGENTS

An Antimicrobial is an agent that kills microorganisms or inhibits their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibacterials (commonly known as antibiotics) are used against bacteria and antifungals are used against fungi. They can also be classed according to their function. Antimicrobials that kill microbes are called microbicidal; those that merely inhibit their growth are called Microbiostatic. Disinfectants such as bleach are non-selective antimicrobials.

HISTORY
Paul Ehrlich and Sahachiro Hata developed Salvarsan (Arsphenamine) against syphilis in 1910: The concept of chemotherapy to treat microbial diseases was born.
Sulfa drugs (sulfanilamide) discovered in 1932 against Gram+ bacteria

EXAMPLES OF ANTI MICROBIAL AGENTS

PENICILLINS CEPHALOSPORINS STREPTOMYCIN BACITRACIN TETRACYCLINES SULPHONAMIDES VANCOMYCIN CIPROFLOXACIN RIFAMPIN

PENICILLINS

Penicillin was the first antibiotic to be used clinically in the treatment of pathogenic diseases. It was discovered as a natural product obtained from the moulds of penicillium genus.

It is a member of broad class of -lactam antibiotics.

ADVERSE EFFECTS OF PENICILLINS

Allergy and Anaphylaxis : skin rashes with pruritus, haematuria, albuminuria and rarely haemolytic anaemia. Anaphylaxis occurs rarely but may be fatal. It typically causes a number of symptoms including an itchy rash, throat swelling, and low blood pressure.

Local Irritancy: oral route: nausea, vomiting and diarrhea. Prolonged iv: thrombophlebitis of injected vein. Large iv: mental confusion, convulsions and coma. Super infections: by suppressing the micro flora of GIT. Hyperkalaemia: causes in renally impaired patients.

STREPTOMYCIN

It was the first amino glycoside antibiotic to be used chemotherapeutically. It is isolated from the actinomycetes bacteria Streptomyces griseus. Resistance is one of the major factors that has limited its use. Hence, it is given along with -lactum antibiotics.

ADVERSE EFFECTS OF STREPTOMYCIN

All amino glycosides are ototoxic, nephrotoxic. Streptomycin has greater potential to cause vestibular damage whereas cochlear damage and nephrotoxicity are relatively less. It commonly causes pain at the site of injection. Allergic reactions like rashes, eosinophilia, fever and exfoliative dermatitis may also occur.

TETRACYCLINES

Tetracyclines are potent, broad spectrum antibiotics, effective against a wide variety of microorganisms. Tetracyclines include both natural and semi synthetic agents. Chlortetracycline is regarded as the prototype of all the existing tetracyclines.

ADVERSE EFFECTS OF TETRACYCLINES

Irritative effects: nausea, vomiting, epigastric pain and diarrhoea. Dose related effects: A)Teeth and bones B)Hepatic damage C)Renal damage D)Phototoxicity E)Diabetes Insipidus

Super infections: Prolonged usage of tetracyclines particularly in diabetes, leucopenia or leukaemia causes superinfections due to suppression of resident flora. Hypersensitivity: it is rarely seen with tetracyclines, rashes, urticaria, pruritus, glossitis, vulvae and dermatitis can occur.

SULFONAMIDES

Sulfonamides contain a sulfanilamide moiety in their chemical structure and possess antibacterial property. They are used to treat bacterial infections that have pyogenic (pus forming) property. They act by inhibiting the synthesis of folic acid which is essential for bacterial metabolism.

ADVERSE EFFECTS OF SULFONAMIDES

Hypersensitivity/Allergic Reactions: Drug fever, skin rash, urticaria. Renal toxicity Haemopoietic toxicity Gastrointestinal Manifestations Kernicterus Nervous system toxicity Endocrinal toxicity

CIPROFLOXACIN

Ciprofloxacin is the prototype drug of first generation fluoroquinolones. They belong to the family of broad spectrum antibiotics. They are bactericidal in nature.

They act by inhibiting DNA gyrase in Gram-negative and topoisomerase IV in Gram-positive organisms.

ADVERSE EFFECTS OF CIPROFLOXACIN

Gastrointestinal Manifestations: stomach ache, digestion disorders.

Nausea,

vomiting,

CNS Manifestations: Dizziness, headache, restlessness, anxiety, insomnia. Hypersensitivity Reactions: Skin rashes, photosensitivity, swelling of lips etc. Tendonitis and tendon ruptures.

RIFAMPIN

Rifampin is a semi synthetic derivative of rifamycin-B. It acts by inhibiting DNA-dependent RNA polymerase of micro organisms leading to the suppression of chain initiation in RNA synthesis. It does not interfere with mammalian RNA polymerase.

ADVERSE EFFECTS OF RIFAMPIN

Rifampin causes hepatitis in patients with pre-existing hepatic disease. Other side effects are as follows A) Cutaneous syndrome: Flushing, rash, pruritus, redness and watering of eyes. B) Abdominal syndrome: Nausea, vomiting. C) Flu syndrome: Fever, chills, headache and body pain.

Urine, faeces, saliva, tears, sweat and sputum of the patients may acquire a harmless orange-red colour. Other serious but rare adverse effects are, A) Respiratory syndrome: Breathlessness associated with shock and collapse. B) Haemolysis and renal failure.

REFERENCE

Pirmohamed M, Breckenridge AM, Kitteringham NR, Park BK. Adverse drug reactions. BMJ. 1998; 316: 12958. Cluff LE. Adverse drug reactions: the need for detection and control. Am J Epidemiol. 1971 Nov;94(5):405408.