effects side ocular induced-Drug  • PART7  

changes with intravitreal injections of penicillin. Topical ocular administration results in a high incidence of sensitivity reactions.

References and Further Reading

Alarcón-Segovia D. Drug-induced antinuclear antibodies and lupus syndromes­ . Drugs 12: 69, 1976.

Crews SJ. Ocular adverse reactions to drugs. Practitioner 219: 72, 1977. Katzman B, et al. Pseudotumor cerebri: an observation and review.

Ann Ophthalmol 13: 887, 1981.

Kawasaki K, Ohnogi J. Nontoxic concentration of antibiotics for intravitreal use – evaluated by human in vitro ERG. Doc Ophthalmol 70: 301–308, 1989.

Laroche J. Modification of color vision by certain medications. Ann Oculist 200: 275–286, 1967.

Leopold IH, Wong EK, Jr. The eye: local irritation and topical toxicity.

In: Cutaneous Toxicity, Drill VA, Lazar P (eds), Raven Press, New York, pp 99–103, 1984.

Robertson CR Jr. Hallucinations after penicillin injection. Am J Dis Child 139: 1074, 1985.

Schmitt BD, et al. Benign intracranial hypertension associated with a delayed penicillin reaction. Pediatrics 43: 50–53, 1969.

Snavely SR, Hodges GR. The neurotoxicity of antibacterial agents. Ann Intern Med 101: 92, 1984.

Tseng SCG, et al. Topical retinoid treatment for various dry-eye disorders. Ophthalmology 92: 717, 1985.

Generic names: 1. Cefaclor; 2. cefadroxil; 3. cefalexin 4. cefazolin; 5. cefditoren pivoxil; 6. cefoperazone sodium; 7. cefotaxime sodium; 8. cefotetan disodium; 9. cefoxitin sodium; 10. cefradine 11. ceftazidime; 12. ceftizoxime sodium; 13. ceftriaxone sodium; 14. cefuroxime;

15. cefuroxime axetil.

Proprietary names: 1. Ceclor; 2. Duricef; 3. Biocef, Cefanex, Keflex, Keftab; 4. Ancef, Zolicef; 5. Spectracef; 6. Cefobid; 7. Claforan; 8. Generic only; 9. Mefoxin; 10. Velosef; 11. Ceptaz, Fortaz, Tazicef, Tazidime;

12. Cefizox; 13. Rocephin; 14. Zinacef; 15. Ceftin.

Primary use

Cephalosporins are effective against streptococci, staphylococci, pneumococci and strains of Escheria coli, Pneumococci mirabilis and Klebsiella.

Ocular side effects

Systemic administration

Certain

1. Eyelids or conjunctiva

a.Allergic reactions

b.Erythema

c.Conjunctivitis – non-specific

d.Edema

e.Angioedema

f.Urticaria

2. Visual hallucinations

Possible

1. Nystagmus

2. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

3. Eyelids or conjunctiva

a.Erythema multiforme

b.Stevens-Johnson syndrome

c.Exfoliative dermatitis

Conditional/Unclassified

1. Corneal edema – peripheral (cefaclor)

2. Acute macular neuroretinopathy

Local ophthalmic use or exposure – topical application or subconjunctival injection

Certain

1. Irritation

a.Hyperemia

b.Ocular pain

c.Edema

2. Eyelids or conjunctiva

a.Allergic reactions

b.Angioedema

c.Urticaria

3. Overgrowth of non-susceptible organisms

Clinical significance

Rarely does this group of drugs given systemically cause ocular side effects. Kraushar et al (1994) reported an anaphylactic reaction to intravitreal cefazolin. There is significant cross-sensi- tivity within this group, as well as with penicillin. Platt (1990) described a generalized allergic event of Type III hypersensitivity, including reversible limbal hyperemia, mild conjunctivitis and peripheral corneal edema, in a patient taking cefaclor. The National Registry has a case of acute macular neuroretinopathy associated with Type III hypersensitivity response in a patient on cefotetan. Platt’s case and the one in the National Registry make one suspicious of a possible association of a Type III hypersensitivity ocular event.

References and Further Reading

Ballingall DLK, Turpie AGG. Cephaloridine toxicity. Lancet 2: 835–836, 1967.

Berrocal AM, Schuman JS. Subconjunctival cephalosporin anaphylaxis. Ophthalmic Sug Las 32(1): 79–80, 2001.

Campochiaro PA, Green R. Toxicity of intravitreous ceftazidime in primate retina. Arch Ophthalmol 110: 1625–1629, 1992.

Green ST, Natarajan S, Campbell JC. Erythema multiforme following cefotaxime therapy. Postgrad Med J 62: 415, 1986.

Jenkins CDG, McDonnell PJ, Spalton DJ. Randomized single blind trial to compare the toxicity of subconjunctival gentamicin and cefuroxime in cataract surgery. Br J Ophthalmol 74: 734, 1990.

Kannangara DW, Smith B, Cohen K. Exfoliative dermatitis during cefoxitin therapy. Arch Intern Med 142: 1031, 1982.

Kramann C, Pitz S, Schwenn O, et al. Effects of intraocular cefotaxime on the human corneal endothelium. J Cataract Refract Surg 27: 250–255, 2001.

Kraushar MF, Nussbaum P, Kisch AL. Anaphylactic reaction to intravitreal cefazolin (letter). Retina 14(2): 187–188, 1994.

Murray DL, et al. Cefaclor-A cluster of adverse reactions. N Engl J Med 303: 1003, 1980.

Okumoto M, et al. In vitro and in vivo studies on cefoperazone. Cornea 2: 35, 1983.

Platt LW. Bilateral peripheral corneal edema after cefaclor therapy. Arch Ophthalmol 108: 175, 1990.

Taylor R, et al. Cephaloridine encephalopathy. BMJ 283: 409, 1981. Villada JR, Ubaldo V, Javaloy J, Alió JL. Severe anaphylactic reaction after

intracameral antibiotic administration during cataract surgery. J Refract Surg 31: 620–624, 2005.