adverse effects of antimicrobials

8/10/2019 Adverse Effects of Antimicrobials

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CASE STUDIES ON "ADVERSE

EFFECTS OF ANTIMICROBIAL

CHEMOTHERAPY"


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Case 1- A therapeutic regimen was planned for

a female patient diagnosed as having chronic

hepatitis C virus infection. The age of thepatient is 35 years, body weight of 57

kilograms. Biochemical tests revealed

moderate elevation of the liver enzymes; AST

and ALT without impairment of liver function.


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One of the Lab tests that should be done to

detect an important side effect of the

selected drug is:a-Blood amylase level

b-Complete blood picture

c-Blood sodium level

d-Blood lactic acid level

Sustained virological response can be

increased by adding the following drug to the

previously selected one:

a-Interferon beta.

b-Ribavirin

c-Telbivudined-Tenofovir

A drug that must be included in the therapeutic

regimen of this patient is:

a- Interferon alpha

b-Lamivudine

c-Adefovir

d-Entecavir


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Among the patient factors in this case that

suggest good virological response to

treatment are:

a-Age of the patient.b-Intact liver function.

c-Level of liver enzymes.

d-All of above.

Adding the drug chosen i to the therapeutic regimen

increases the risk of the following side effect:

a-Hepatotoxicity.

b-Anaemiac-Neurotoxicity

d-Thyroid dysfunction


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A 20-year-old woman with leukemia was undergoing

chemotherapy with intravenous antineoplastic drugs.

During treatment, she developed fever, cough. Her

throat was sore and white plaques appeared in her

pharynx. Blood neutrophilic count was 400/l. After

appropriate specimens were obtained for culture,empiric antibiotic therapy was started with

gentamicin, nafcillin, and ticarcillin intravenously.

The patientscondition did not improve . On day 4,

both the blood and urine culture grew out Candida

albicansand no bacterial growth.

Case Number 2


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Possible fungal infections: Persistent fever,

neutropenia, chest symptoms, or the presence of

pulmonary infiltrations on chest radiographs

Probable fungal infections: Persistent fever,

neutropenia, and infiltrates characteristic of fungal

pneumonia on a CT

Proved fungal infections: Typical infiltrates on a CTand detection of moulds in bronchoalveolar lavage or

bronchial secretions by culture during neutropenia


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The best course of action is to:

a. Continue current antibiotics and start

amphotericin B

b. Continue current antibiotics and start flucytocinec. Continue current antibiotics and start

ketoconazole

d. Stop current antibiotics and start amphotericin B


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Before administering amphotericin, the

patient is better to be premedicated with:

a. IV fluidsb. NSAID

c. Corticosteroid

d. All of the above


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The dose limiting toxicity of amphotericin B is

a. Hepatitis

b. Hypotensionc. Nephrotoxicity

d. Anaphylactic shock


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The opportunistic fungal infection in this

patient could have been prevented byadministration of:

a. Nystatin

b. Fluconazolec. Amphotericin B

d. None of the above


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A 52 year old man presents with abdominal pain,which has been worsening over the past week.

He is now having 8-10 watery stools a day and

mild cramping pain. About 10 days ago reveledthat he has completed a course of

amoxicillin/clavulanic acid for pneumonia. A

stool culture is negative but specific toxin assay

is positive. The condition was diagnosed as

Pseudomembranous colitis.

Case No 3


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1. What is the predisposing factor for

such a case?a. Low immunity.

b. Age of the patient

c. Amoxicillin/ Clavulenic acid.d. Dehydration


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2. Pseudomembranous colitis is afrequent complication of the following

antibiotic:

a. Penicillin G.B. Clindamycin.

C. Streptomycin.

D. Vancomycin


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Case No: 4

A 59-year-old man received one of the macrolidegroups of antibiotics for cough treatment after he has

been taking numerous over-the-counter cold

medications without relief. After three days therapy

the patient suffered from cardiac arrhythmia. What isthe possible explanation for this arrhythmia?


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Case No: 5

The patient received erythromycin which inhibitedhepatic metabolism of the antihistaminic present in

OTC cough therapy, resulting in increased serum

concentration of the antihistaminic and appearance of

one of antihistaminic side effects which is arrhythmia.


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3.An antibiotic that doesn't inhibit CYP-450enzymes:

a. Telithromycin.

b. Azithromycin

c. Clarithromycind. Any of the above


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Case Number6:

A child while receiving his second procainepenicillin injection ( for treatment of acute

tonsillitis) suddenly collapsed, with fainting,

cyanosis and severe pallor. A diagnosis ofanaphylactic shock was made.


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Case Number 7:

A woman presented her 5-years old son to thepediatric dental office with a certain heath

problem. The physician noticed yellowishdiscoloration which is nonbrush able. Shementioned that this color was found since years .The doctor asked the woman of previous exposure

of the child to drugs.


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5. The time of exposure that enhances this problem is

a. During fetal life.b. In nursing period

c. In early child hood.

d. Any of the above.


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Remember

Penicillins

Hypersensitivity ReactionsGIT symptoms with oral

penicillins


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Aminoglycosides

Ototoxicity

NephrotoxicityNeurotoxicity


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Chloramphenicol

Grey baby syndrome

Anemia Types ?

Drug Interactions


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TetracyclineFluoroquinolne

Bone , teeth effectsTendon and cartilage

effects

Photosensitivity


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SULPHONAMIDES

Hypersensitivity

Haemolytic anemia ?

Kernictrus ?

adverse effects of antimicrobials

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