Shaking, Chills, and Rigors with Once‐Daily Gentamicin

Lucas, Kristy H.; Schliesser, Shelley H.; OʼNeil, Michael G.

doi:10.1592/phco.19.13.1102.31596

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…Antibiotic-induced tremors are less frequently observed (Table 1 ) [ 4 - 16 ]. They are not restricted to a specific class of drugs and have occurred after initiating treatment with aminoglycosides, carbapenems, cephalosporins, fluoroquinolones, folate synthesis inhibitor, glycopeptides, macrolides, penicillins, and tetracyclines.…”

Section: Discussionmentioning

confidence: 99%

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Doxycycline-Induced Hand Tremors: Case Report and Review of Antibiotic-Associated Tremors

Jacob¹,

Cohen²

2020

Cureus

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There are several etiologies for acquired tremors. Medications have been observed to induce tremors. A 64-year-old man initiated oral doxycycline for scalp folliculitis. By the third dose, he noticed development of hand tremors. He continued the medication and the tremor persisted. Doxycycline was stopped after five days. Within three days of discontinuing the drug, all tremors had resolved. Medication-induced tremors have been associated with several drugs. These include antiarrhythmics, antibiotics, antidepressants, antiepileptics, antimycotics, antivirals, bronchodilators, chemotherapeutics, dopamine depleters, drugs of misuse, gastrointestinal drugs, hormones, immunosuppressants, methylxanthines, mood stabilizers, and neuroleptics. Several antibiotics have also been associated with drug-induced tremors. These include aminoglycosides, carbapenems, cephalosporins, fluoroquinolones, folate synthesis inhibitor, glycopeptides, macrolides, penicillins, and tetracyclines. Doxycycline can be added to the list of drugs associated with medication-induced tremors.

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Section: Discussionmentioning

confidence: 99%

“…A 21-year-old woman was treated for endometritis two days after a cesarean section. One hour after a gentamicin infusion, she experienced shaking, chills, and rigors that resolved with administration of intravenous diphenhydramine [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Doxycycline-Induced Hand Tremors: Case Report and Review of Antibiotic-Associated Tremors

Jacob¹,

Cohen²

2020

Cureus

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“…The typical reaction that is associated with gentamicin is fever and chills (57%), rigor (20%), shivering (33%), tachycardia with hypertension or hypotension (41%) and respiratory symptoms (22%). Muscle cramps, tremors, aches, rash and malaise are not uncommon 5,6 . These typically begin within 3 h of gentamicin administration and are dose dependent.…”

Section: Discussionmentioning

confidence: 99%

Endotoxin‐like reaction following once‐daily gentamicin

Aly

Sivasubramaniam

et al. 2009

Acta Anaesthesiol Scand

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An endotoxin-like reaction is a host response to an agent that induces the release of endogenous pyrogens, including cytokines. The typical reaction that is associated with gentamicin is fever and chills, rigor, shivering, tachycardia with hypertension or hypotension, respiratory symptoms and muscle cramps. We report a case of a 92-year-old patient who developed an endotoxin-like reaction in the post-operative recovery unit following 200 mg of gentamicin. The reported side effect is not included in the drug sheet or in the British National Formulary. No similar incidents were reported in the UK. We discuss the clinical picture of this rare event, along with a review of the literature and recommendations.

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“…The patient remained euthymic and was dismissed in a stable condition. Psychiatric and neurological adverse effects have been reported with use of several antibiotics [2,4,5] . However the development of dyskinesia is described only in patients who were treated with substances such as ofl oxacin [2] .…”

mentioning

confidence: 99%

EPMS Under Antidepressive Therapy With Fluvoxamine and Concomitant Antibiotic Therapy With Clindamycin

Jakob¹,

Wolf²

2007

Pharmacopsychiatry

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A 32-year-old man with a history of DSM-IV recurrent depression for 10 years was admitted in August 2005 for a major depressive episode without psychotic features. His Hamilton Depression Rating Scale (HDRS 17) score was 25, with the main complaints being depressive mood, adynamia, anhedonia, difficulties in concentration, and hemicrania as a somatic symptom. Before admission the last medication consisted of 100 mg fl uvoxamine for 10 days in a stable dose. Up to then no side effects had occurred. No signifi cant fi ndings were obtained by the physical examination. EEG, ECG, and MRI showed no abnormalities, and the patient had no history of seizures. After admission the dose of fl uvoxamine was increased to 200 mg within one day. Within four weeks of treatment under this regimen, the patient became euthymic. His HAMD 17 score decreased to 6 points. No side effects occurred under this treatment. During his last week in hospital the patient developed an axillary furuncle. Upon the recommendation of the consulted dermatologist, an antibiotic medication with clindamycin 300 mg per day was initiated. Forty-eight hours later the patient developed severe orofacial dyskinesia. Further diagnostics such as neurological and physical examination showed no abnormalities. In addition, no hint of any further substance intake could be found. After intravenous application of 2.5 mg biperiden, the orofacial dyskinesia disappeared immediately. The antibiotic medication was discontinued right away. The directly measured blood level of fl uvoxamine resulted in a subtherapeutic fl uvoxamine level of 90 ng / mL (normal range 150 -300 ng / mL [1] ). Thirty-six hours after treatment with clindamycin was stopped, we began a new antibiotic medication (Unacid). Under this treatment no further clinical abnormalities occurred, especially no extrapyramidal adverse effects. The patient remained euthymic and was dismissed in a stable condition. Psychiatric and neurological adverse effects have been reported with use of several antibiotics [2,4,5] . However the development of dyskinesia is described only in patients who were treated with substances such as ofl oxacin [2] . To our knowledge no reports of extrapyramidal adverse effects associated with clindamycin exist. On the other hand, considering the close temporal connection between the intake of clindamycin and the development of EPS and given that fl uvoxamine was administered at a stable dose for more than four weeks, we suggest that there might be a causal connection as well. However there are no data suggesting clindamycin itself to be directly associated with the development of EPS. Furthermore, it is diffi cult to fi nd a direct neurobiological explanation considering that clindamycin is not known to infl uence the transmitter systems of dopamine, noradrenaline, or serotonin [3] . Despite the measured subtherapeutic blood level of fl uvoxamine at this time, there is a possibility that the origin of EPS was based upon fl uvoxamine and pharmacological interactions between clindamycin and ...

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Shaking, Chills, and Rigors with Once‐Daily Gentamicin

Cited by 5 publications

References 2 publications

Doxycycline-Induced Hand Tremors: Case Report and Review of Antibiotic-Associated Tremors

Doxycycline-Induced Hand Tremors: Case Report and Review of Antibiotic-Associated Tremors

Endotoxin‐like reaction following once‐daily gentamicin

EPMS Under Antidepressive Therapy With Fluvoxamine and Concomitant Antibiotic Therapy With Clindamycin

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