CASE STUDIES ON "ADVERSE

EFFECTS OF ANTIMICROBIAL
CHEMOTHERAPY"

Case 1- A therapeutic regimen was planned for

a female patient diagnosed as having chronic
hepatitis C virus infection. The age of the
patient 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.

A drug that must be included in the therapeutic

regimen of this patient is:
a- Interferon alpha
b-Lamivudine
c-Adefovir
d-Entecavir

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-Telbivudine
d-Tenofovir

Adding the drug chosen i to the therapeutic regimen

increases the risk of the following side effect:
a-Hepatotoxicity.
b-Anaemia
c-Neurotoxicity
d-Thyroid dysfunction

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.

Case Number 2

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 patients condition did not improve . On day 4,
both the blood and urine culture grew out Candida
albicans and no bacterial growth.

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 CT
and detection of moulds in bronchoalveolar lavage or
bronchial secretions by culture during neutropenia

The best course of action is to:

a. Continue

current antibiotics and start

amphotericin B
b. Continue current antibiotics and start flucytocine
c. Continue
current antibiotics and start
ketoconazole
d. Stop current antibiotics and start amphotericin B

Before administering amphotericin, the

patient is better to be premedicated with:
a. IV fluids
b. NSAID
c. Corticosteroid
d. All of the above

The dose limiting toxicity of amphotericin B is

a. Hepatitis
b. Hypotension
c. Nephrotoxicity
d. Anaphylactic shock

The opportunistic fungal infection in this

patient could have been prevented by
administration of:
a. Nystatin
b. Fluconazole
c. Amphotericin B
d. None of the above

Case No 3
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 reveled
that 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.

1. What is the predisposing factor for

such a case?
a. Low immunity.
b. Age of the patient
c. Amoxicillin/ Clavulenic acid.
d. Dehydration

2. Pseudomembranous colitis is a
frequent complication of the following
antibiotic:
a. Penicillin G.
B. Clindamycin.
C. Streptomycin.
D. Vancomycin

Case No: 4
A 59-year-old man received one of the macrolide
groups 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 is
the possible explanation for this arrhythmia?

Case No: 5
The patient received erythromycin which inhibited
hepatic 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.

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

enzymes:
a. Telithromycin.
b. Azithromycin
c. Clarithromycin
d. Any of the above

Case Number 6:

A child while receiving his second

procaine
penicillin injection ( for treatment of acute
tonsillitis) suddenly collapsed, with fainting,
cyanosis and severe pallor. A diagnosis of
anaphylactic shock was made.

After life saving of this child, the doctor

decided to give him another antibiotic. A
suitable one is:
A- Ceftriaxone
B- Ciprofloxacin
C- Minocycline
D- Azithromycin

Case Number 7:

A woman presented her 5-years old son to the

pediatric
dental office with a certain heath
problem. The physician noticed yellowish
discoloration which is nonbrush able. She
mentioned that this color was found since years .
The doctor asked the woman of previous exposure
of the child to drugs.

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.

Remember

Penicillins
Hypersensitivity Reactions
GIT symptoms with oral
penicillins

Aminoglycosides
Ototoxicity

Neurotoxicity

Nephrotoxicity

Chloramphenicol

Grey baby syndrome

Anemia

Types ?

Drug Interactions

Fluoroquinolne

Tetracycline

Bone , teeth effects

Tendon and cartilage

effects

Photosensitivity

SULPHONAMIDES

Hypersensitivity

Haemolytic anemia ?

Kernictrus ?