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There is recent enhanced interest in the potential of medication to produce serious toxicity, and the television media have focused on the serious side effects and drug-drug interactions caused by antibiotics. In fact, a recent hospital study noted that drug-related toxicity was one of the most common causes of death for hospitalized patients. Antibiotic-induced adverse events contribute to host injury diagnostic confusion and excessive medical costs. In addition, however, a "spin-off'' of antibiotic-induced adverse events is the emergence and dissemination of drug-resistant organisms. This chapter will describe the adverse events and drug-drug interactions produced by those antibiotics that are most commonly prescribed to patients to prevent or treat respiratory tract infections. An effort will also be made to focus on those unique settings (the patient with renal insufficiency, the patient receiving immunosuppressive medication, the pregnant patient, the elderly patient, and the HIV-infected patient who is a candidate for primary or secondary prophylaxis for Pneumocystis carinii) that require a knowledge of antibiotic-induced adverse events.

Infectious arthritis in renal transplant patients may be a commonly diagnosed condition with traditional bacterial organisms isolated. However, since nontuberculous mycobacteria are ubiquitous in the environment, immunocompromised individuals may suffer from infections with these organisms. Concomitant gout and Mycobacterium avium intracellulare septic arthritis is described for the first time in this clinical setting. Appropriate cultures should be performed even in the setting of crystal arthritis in posttransplant patients when clinically indicated.

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The patient described was successfully treated without having to remove her nephrostomy tubes. Two other authors have reported the successful use of fluconazole irrigation to treat candidiasis in nephrostomy tubes that was unresponsive to systemic fluconazole. Before the appearance of these reports, the best results were obtained with removal of the catheter in renal candidiasis.

We report a case of bacteremic nonmenstrual staphylococcal toxic shock syndrome (STSS) producing staphylococcal enterotoxins A and C. The bloodstream isolation of Staphylococcus aureus, as well as the production of enterotoxins A and C, are unusual as separate entities, and distinctly uncommon when found together.

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