Important side effects/toxicities of antibiotics and advisable monitoring procedures for MAC and MABSC in CF
| Drug | Common side effects/toxicity | Monitoring procedures |
|---|---|---|
| Amikacin | Nephrotoxicity | Regular serum amikacin levels* Regular serum creatinine levels |
| Auditory-vestibular toxicity (tinnitus, high-frequency hearing loss) | Symptoms, baseline and interval audiograms | |
| Azithromycin | Nausea, vomiting, diarrhoea | Symptoms |
| Auditory-vestibular toxicity | Symptoms, audiogram | |
| Prolonged QT | ECG | |
| Clarithromycin | Hepatitis | Liver function tests |
| Taste disturbance | Symptoms | |
| Inhibited hepatic metabolism of rifabutin | Symptoms | |
| Cefoxitin | Fever, rash | Symptoms |
| Eosinophilia, anaemia, leucopaenia, thrombocytopaenia | Full blood count | |
| Interference with common assays to measure serum creatinine | Use alternative assay | |
| Clofazimine | Discoloration of skin† | Symptoms |
| Enteropathy (sometimes mimicking pancreatic insufficiency)† | Symptoms | |
| Nausea and vomiting | Symptoms | |
| Co-trimoxazole | Nausea, vomiting, diarrhoea | Symptoms |
| Anaemia, leucopoenia, thrombocytopaenia | Full blood count | |
| Fever, rash, Stevens-Johnson syndrome | Symptoms | |
| Ethambutol | Optic neuritis | Symptoms (loss of colour vision/acuity) Baseline and interval testing for colour vision and acuity‡ Ophthalmology opinion if symptoms occur |
| Peripheral neuropathy | Symptoms; nerve conduction studies | |
| Imipenem | Hepatitis | Liver function tests |
| Imipenem (cont) | Nausea, vomiting, diarrhoea | Symptoms |
| Linezolid | Anaemia, leucopaenia, thrombocytopaenia | Full blood count |
| Peripheral neuropathy | Symptoms/clinical evaluation/electrophysiology | |
| Optic neuritis | Symptoms (loss of colour vision/acuity) Baseline and interval testing for colour vision and acuity Ophthalmology opinion if symptoms occur | |
| Moxifloxacin | Nausea, vomiting, diarrhoea | Symptoms |
| Insomnia, agitation, anxiety | Symptoms | |
| Tendonitis | Symptoms | |
| Photosensitivity | Symptoms | |
| Prolonged QT | ECG | |
| Minocycline | Photosensitivity | Symptoms |
| Nausea, vomiting, diarrhoea | Symptoms | |
| Vertigo | Symptoms | |
| Skin discolouration | Clinical evaluation | |
| Rifampin and rifabutin | Orange discolouration of bodily fluids (can stain contact lenses) | Symptoms |
| Hepatitis | Liver function tests | |
| Nausea, vomiting, diarrhoea | Symptoms | |
| Fever, chills | Symptoms | |
| Thrombocytopaenia | Full blood count | |
| Renal failure (rifampin) | Blood tests | |
| Increased hepatic metabolism of numerous drugs | Dose adjustment of other medications/serum levels where available | |
| Rifabutin | Leucopaenia, | Full blood count |
| Anterior uveitis (when combined with clarithromycin) | Symptoms | |
| Flu-like symptoms polyarthralgia, polymyalgia | Symptoms | |
| Streptomycin | Nephrotoxicity | Regular serum streptomycin levels Regular serum creatinine levels |
| Auditory-vestibular toxicity (tinnitus, high frequency hearing loss) | Symptoms, baseline and interval audiograms | |
| Tigecycline | Nausea, vomiting, diarrhoea | Symptoms |
| Pancreatitis | Serum amylase§ | |
| Hypoproteinaemia | Serum albumin | |
| Bilirubinaemia | Serum bilirubin |
*Usually aiming for peak levels of 20–30 µg/mL and trough levels of <5–10 µg/mL.
†It may take up to 3 months for toxicity to resolve following cessation of clofazimine due to its long half-life.
‡Monthly checks if receiving 25 mg/kg/day.
§In individuals with pancreatic sufficiency.
CF, cystic fibrosis; MABSC, Mycobacterium abscessus complex; MAC, Mycobacterium avium complex.