A, β-lactam antibiotics adverse reactions (a), penicillin penicillin is through the inhibition of the synthesis of the bacterium cell wall to play a bactericidal effect. Because human cells do not have a cell wall, penicillin has almost no effect on it. And because penicillin antibacterial spectrum is very wide. Therefore, it is very popular among patients. It has become one of the most commonly used antibiotics in clinical practice. However, due to the increase in the use of penicillin in large doses and high concentrations in recent years, its adverse reactions have occurred repeatedly. Penicillin common adverse reactions are: 1, allergic reactions: more common, including urticaria and other types of rash, leukopenia, interstitial nephritis, asthma attacks, and serum sickness-type reactions; 2, toxic reactions: rare, but intravenous infusion of large doses of this product or intrathecal administration, can lead to convulsions, muscle clonus, coma and severe psychiatric symptoms due to high cerebrospinal fluid concentration; 3, Hirschsprung’s reaction and treatment contradiction: with Penicillin treatment of syphilis and other diseases can cause increased symptoms due to the death of the pathogen, called Hirschsprung’s reaction. Treatment contradiction is also seen in syphilis patients, because the treatment of syphilis lesions disappear too quickly, while the tissue repair is relatively slow or the fibrous tissue contraction at the site of the lesion, which hinders the function of organs; 4, secondary infection: penicillin-resistant Staphylococcus aureus, gram-negative bacilli or Candida and other secondary infections can occur; 5, the application of high-dose sodium penicillin can lead to heart failure due to the intake of large amounts of sodium salt. (B), cephalosporins Cephalosporin antibiotics, also known as vanguardycin, is a class of broad-spectrum semi-synthetic, β-lactam antibiotics. At present, there are four generations of products, the application is very wide. Clinical findings, cephalosporin antibiotics have the following common adverse reactions: 1, allergic reactions: cephalosporins can cause rash, urticaria, asthma, drug fever, serum sickness-like reactions, angioneurotic edema, anaphylaxis and other adverse reactions. Anaphylaxis of cephalosporins is similar to penicillin shock reactions. Incomplete cross-allergic reactions are presented between the two classes of drugs. Therefore, it should be used with caution for those who are allergic and hypersensitive to penicillin. Some products provide for skin test before use in the instruction, which should be implemented with reference. 2. Gastrointestinal reactions and dysbiosis: Most cephalosporins can cause nausea, vomiting, loss of appetite and other reactions. Cephalosporins have a strong inhibitory effect on intestinal flora. Long-term or high-dose use of cephalosporin antibiotics can lead to dysbiosis of flora and cause vitamin B and K deficiency. In addition, it can also cause secondary infection, such as pseudomembranous enteritis, Candida infection, etc., especially the second and third generation cephalosporins. 3.Hepatotoxicity: Most of the cephalosporins can lead to the increase of aminotransferase, alkaline phosphatase, blood bilirubin and other values when applied in large doses. 4.Hematopoietic system toxicity: Cephalosporins can occasionally cause erythrocyte or leukopenia, thrombocytopenia, eosinophilia, etc. 5.Renal damage: Most of the cephalosporins are excreted by the kidneys, with the first and second generation cephalosporins being the most common, occasionally causing blood urea ammonia, blood creatinine value increase, oliguria, proteinuria, etc.. Among them, ceftazidime has the most significant renal damage effect. Cephalosporin combined with high efficiency diuretics or aminoglycoside antibiotics, renal damage is significantly enhanced. 6. Coagulation dysfunction: Because cephalosporin antibiotics can inhibit the production of vitamin K by intestinal flora, which makes the coagulation mechanism impaired and therefore has potential bleeding-causing effects. The occurrence of coagulation dysfunction is directly related to the size of the dosage of cephalosporin antibiotics and the duration of treatment. 7, combined with ethanol: produce “disulfiram” (abstinence from alcohol sulfur)-like reaction, inhibition of acetaldehyde dehydrogenase, so that the accumulation of acetaldehyde in the body of drinkers to produce unpleasant reaction and used for abstinence from alcohol. Cephalosporins containing thiomethyl tetrazolium group have the function of disulfiram. When combined with ethanol application (drinking or exposure to alcohol, etc.), it can also cause the accumulation of acetaldehyde in the body and “drunkenness”. The quinolones are synthetic antibiotics, mainly including norfloxacin, ciprofloxacin, ofloxacin, enoxacin, flurofloxacin, pefloxacin, gatifloxacin, lomefloxacin and so on. These antibiotics have a wide antibacterial spectrum, high efficiency, easy to use and few adverse reactions. The mechanism of action is to inhibit the synthesis of bacterial nucleic acid, which is significantly different from other antibiotics, and will not form cross-resistance with other antimicrobials, and still has good antibacterial activity against resistant strains of other antimicrobials. Therefore, quinolone antibiotics have become the most widely developed and applied class of drugs in clinical practice, mainly used in the treatment of infectious diseases of the genitourinary system, respiratory system and digestive system. 1, gastrointestinal reactions: In the adverse reactions of quinolone antibiotics, gastrointestinal reactions are the most common. About 3% to 5% of patients will have gastrointestinal symptoms such as loss of appetite, epigastric pain, nausea, vomiting, diarrhea or constipation after taking this type of drugs. In recent years, with the introduction of the third generation of quinolone antibiotics and the reform of the dosage form, the incidence of gastrointestinal reactions has been reduced, and even if they occur, the symptoms are mild. Therefore, as long as you follow the doctor’s instructions, and pay attention to take the drug before meals, after taking the drug in time to eat, the majority of patients can avoid the appearance of this adverse reaction. 2, central nervous system reactions: clinical statistics show that in patients taking the third-generation quinolones enoxacin (fludioxonate), about 2% will appear drowsiness, headache, dizziness and limb numbness and other mild symptoms. Causing these reactions in the central nervous system is mainly related to taking too large a dose and too long a dose. This is due to the fact that quinolones can cross the blood-brain barrier. If the dose is too large or the dosing time is too long, the amount of drugs that cross the blood-brain barrier will increase, which can affect the function of the limbic system of the brain and can lead to neurological symptoms in patients. Therefore, when taking quinolones, the dosage must be strictly controlled and the dosage and number of doses should not be increased at will; at the same time, attention should be paid to the duration of the medication, and the general use of quinolones should be controlled in about 5-7 days. If the above-mentioned symptoms occur during the medication, we should promptly reduce the dose, and if necessary, stop the medication or adjust the medication under the guidance of a doctor. 3, general allergic reactions: in taking quinolone antibiotics, there are very few patients will appear rash, drug fever and hives and other general allergic performance. Compared to other antibiotics, the incidence of allergic reactions to these drugs is low and will not cause serious allergic symptoms such as anaphylaxis. All that is needed is to stop the drug immediately and take appropriate anti-allergy medication such as cetirizine, or topical anti-itch agents. If necessary, glucocorticoids can be added under the guidance of a doctor. In this way, the symptoms can be quickly relieved and allergic reactions such as rashes and hives can be eliminated. 4, photosensitivity dermatitis: fleroxacin, lomefloxacin is common, is a drug metamorphosis, often in 7 to 10 days after the use of drugs. 5, abnormal blood sugar: mainly gatifloxacin. Including symptomatic hypoglycemia and hyperglycemia. In severe glucose abnormalities, including hypertonic non-ketotic hyperglycemic coma, diabetic ketoacidosis, hypoglycemic coma, seizures and altered mental status (including loss of consciousness). Although a few lead to fatal consequences, most of these events are reversible if properly managed. Macrolides (erythromycin, roxithromycin, erythromycin amber, clarithromycin, azithromycin, and cross-amycin) Macrolide antibiotics, represented by erythromycin, have been in use since 1952 and have been the drug of choice for this class of drugs. After that, similar varieties have been marketed one after another, and their toxic side effects are low, and short-term use rarely requires discontinuation of the drug due to toxic reactions. However, most of the macrolide oral drugs, which started as free bases for direct oral use, are not well absorbed and easily destroyed by gastric acid. Now some varieties have overcome the previous shortcomings by esterification, and other shortcomings have arisen, such as erythromycin succinate, acetylmethomycin, azithromycin, etc. Although the absorption rate has been improved and the destruction by gastric acid has been avoided, the toxicity to the liver has increased significantly, and the toxic side effects of roxithromycin and azithromycin have been gradually recognized. The main adverse reactions of such antibiotics are: 1. Toxicity to the liver: in normal doses, the toxicity to the liver is small, long-term application of large quantities can cause bile depression, liver enzymes rise, etc., and can generally be restored after stopping the drug. However, such drugs after esterification (such as roxithromycin, erythromycin, azithromycin, etc.) are more toxic to the liver, and should be used in reduced doses for a short period of time, and should be used with caution in patients with hepatic insufficiency. 2, the impact on the vestibular system: intravenous administration can occur tinnitus, hearing impairment, etc., can be restored after discontinuation or reduction of dosage. 3, allergic reactions: mainly manifested as drug fever, drug rash, urticaria, etc., should be discontinued when the reaction is serious. 4, gastrointestinal reactions: some drugs can cause abdominal pain, diarrhea, nausea, etc., which can be recovered after stopping the drug. 5.Local irritation: Injection administration can cause local irritation, so this kind of drugs should not be used for intramuscular injection. Intravenous drip can cause phlebitis, so the drip solution should be diluted to less than 0.1%, and the drip speed should not be too fast. 6, inhibition of theophylline metabolism: this class of drugs can inhibit the normal metabolism of theophylline, so it is not suitable to be used in combination with aminophylline drugs, to prevent theophylline concentration abnormally high and cause poisoning, or even death. Theophylline concentration monitoring should be carried out in hospital when it must be used to prevent accidents. 7. Some drugs are easy to pass through the placenta: such as clarithromycin and azithromycin. Therefore, pregnant women and nursing mothers need to use with caution, and if necessary, it is advisable to suspend breastfeeding. IV. Tetracycline antibiotics 1. Gastrointestinal reactions. 2. Liver damage. 3, kidney damage. 4, affect the development of teeth and bones, so pregnant women, lactating women and children under 8 years old are prohibited. 5.There is local irritation, so it should not be injected intramuscularly. 6.Allergic reaction. 7, the use of a slightly longer time, easy to cause intestinal flora imbalance. V. Aminoglycosides (streptomycin, gentamicin, kanamycin, amikacin (bupropion)) 1. Neuromuscular blockade: The mechanism of neuromuscular blockade by aminoglycosides is due to the inhibition of presynaptic acetylcholine (Ach) release and the blockade of postsynaptic Ach receptors. This phenomenon is rare but dangerous. Clinical manifestations include numbness in the hands and feet, tongue tremors, and even generalized convulsions, which are sometimes difficult to distinguish from meningitis convulsions. The combination of aminoglycosides and muscle relaxants such as Valium can aggravate the reaction, such drugs should not be pushed intravenously. 2, nephrotoxicity: neonates, premature infants, the elderly is the most harmful (streptomycin, gentamicin) aminoglycoside antibiotics on the kidney toxicity mainly damage the epithelial cells of the proximal tubule, generally do not affect the glomerulus. 3, ototoxicity: mainly gentamicin. The drug on the VIII pair of brain nerve selective damage site is different, the clinical manifestations are also different. It can be divided into: (1) Cochlear nerve damage: a sense of ear swelling and fullness, dizziness, tinnitus, hearing loss, and even deafness. (2) Vestibular dysfunction: balance disorders, vertigo, nausea, vomiting, and eye paroxysms may occur. However, these two types of symptoms are not absolute, and it is possible to have both. Sometimes, the clinical symptoms are not obvious and can only be detected by instrumental examination of vestibular function or hearing. These drugs can cross the placental barrier and cause damage to the fetal brain nerve VIII, which is an important cause of congenital deafness. 4, allergic reactions: clinical manifestations are mainly: anaphylaxis, rash, allergic purpura, angioneurotic edema, allergic death. Among them, the incidence of streptomycin allergic reaction is high and can cause anaphylaxis. It should be noted. 5, hematopoietic system toxic reactions: streptomycin can cause granulocyte deficiency, kanamycin, gentamicin can cause leukopenia. 6.Dual infections: prolonged use of drugs can cause dual infections, such as gentamicin, kanamycin, amikacin, etc. 7, other: a few others can cause respiratory muscle paralysis, resulting in respiratory depression or suspension. In addition, some aminoglycosides can cause liver damage, with elevated transaminases and even jaundice. It can also cause peripheral neuritis, but it is less common. Sixth, sulfonamides 1, allergic reactions; 2, urinary system damage: depends on the concentration and solubility of the drug in the urine (pay attention to the first dose doubled, drink more water during the dosing period to accelerate dissolution), mostly produce hematuria, stones, not combined with vitamin C; 3, blood system damage; 4, liver damage. Seven, chloramphenicol class (chloramphenicol, methylsulfonamides) 1, bone marrow inhibition: irreversible inhibition (aplastic anemia), reversible inhibition (can be restored by stopping the drug). 2.Grey infant syndrome. 3, Gastrointestinal irritation. Lincomycin (lincomycin, clindamycin) 1, gastrointestinal reactions. 2, pseudomembranous enteritis: severe cases can be fatal, the first symptom is diarrhea, in this case, the drug should be immediately stopped, if necessary, available vancomycin treatment. Nine, peptide antibiotics and antifungal drugs: mainly gastrointestinal reactions.