effects side ocular induced-Drug  • PART7  

Generic name: Nalidixic acid.

Proprietary names: None.

Primary use

This bactericidal naphthyridine derivative is effective against E. coli, Aerobacter and Klebsiella. Its primary clinical use is against Proteus.

Ocular side effects

Systemic administration

Certain

1.Visual sensations

a.Glare phenomenon

b.Flashing lights – white or colored

c.Scintillating scotomas – may be colored

2.Problems with color vision

a.Color vision defect

b.Objects have green, yellow, blue or violet tinge

3.Photophobia

4.Paresis of extraocular muscles

5.Papilledema secondary to intracranial hypertension

6.Decreased vision

7.Decreased accommodation

8.Nystagmus

9.Eyelids or conjunctiva

a.Photosensitivity

b.Angioedema

c.Urticaria

10. Visual hallucinations

Possible

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

2. Eyelids or conjunctiva – lupoid syndrome

Clinical significance

Numerous ocular side effects due to nalidixic acid have been ­reported. The most common adverse ocular reaction is a curious visual disturbance, which includes brightly colored appearances of objects as the main feature. This often appears soon after the drug is taken. Temporary visual loss has also occurred and lasted from half an hour to 72 hours. Probably the most serious ocular reaction is papilledema secondary to elevated intracranial pressure. Most of the reports concerning intracranial hypertension deal with children and adolescents, the oldest being 20 years of age. A large series of intracranial hypertension occurred in infants below 6 months of age given 100–150 mg/kg/day for acute bacillary dysentery (Van Dyk and Swan 1969). Use of nalidixic acid during pregnancy carries the possible prenatal risk of increased intracranial pressure. Most adverse ocular reactions due to nalidixic acid are transitory and ­reversible if the dosage is decreased or the drug is discontinued.

References and Further Reading

Birch J, et al. Acquired color vision defects. In: Congenital and Acquired Color Vision Defects, Pokorny J, et al (eds), Grune & Stratton, New York, pp 243–350, 1979.

Drugs that cause psychiatric symptoms. Med Lett Drugs Ther 28: 81, 1986. Gedroyc W, Shorvon SD. Acute intracranial hypertension and nalidixic acid

therapy. Neurology 32: 212, 1982.

Granstrom G, Santesson B. Unconsciousness after one therapeutic dose of nalidixic acid. Acta Med Scand 216: 237, 1984.

Haut J, Haye C, et al. Disturbances of color perception after taking nalidixic acid. Bull Soc Ophthalmol France 72: 147–149, 1972.

Katzman B, et al. Pseudotumor cerebri: an observation and review. Ann Ophthalmol 13: 887, 1981.

Kilpatrick C, Ebeling P. Intracranial hypertension in nalidixic acid therapy. Med J Aust 1: 252, 1982.

Lane RJM, Routledge PA. Drug-induced neurological disorders. Drugs 26: 124, 1983.

Mukherjee A, Dutta P, Lahiri M, et al. Benign intracranial hypertension after nalidixic acid overdose in infants. Lancet 335: 1602, 1990.

Riyaz A, Abbobacker CM, Streelatha PR. Nalidixic acid induced pseudo­ tumor cerebri in children. J Indian Med Assoc 96(10): 308–314, 1998.

Rubinstein A. LE-like disease caused by nalidixic acid. N Engl J Med 301: 1288, 1979.

Safety of antimicrobial drugs in pregnancy. Med Lett Drugs Ther 27: 93, 1985. Van Dyk HJL, Swan KC. Drug-induced pseudotumor cerebri. In: Symposium on

Ocular Therapy, Vol. 4, Leopold IH (ed), Mosby, St Louis, pp 71–77, 1969. Wall M. Idiopathic intracranial hypertension. Neurol Clin 9: 73, 1991.

Generic name: Neomycin.

Proprietary names: Mycifradin, Neo-fradin.

Primary use

These bactericidal aminoglycosidic agents are effective against

Ps. aeruginosa, Aerobacter, K. pneumoniae, P. vulgaris, E. coli, Salmonella, Shigella and most strains of S. aureus.

Ocular side effects

Systemic administration (neomycin powder to mucus membranes)

Probable

1. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles

2. Decreased or absent pupillary reaction to light

Local ophthalmic use or exposure – topical application or subconjunctival injection

Certain

1. Irritation

a.Hyperemia

b.Ocular pain

c.Edema

d.Burning sensation 2. Eyelids or conjunctiva

a.Allergic reactions

b.Erythema

c.Blepharoconjunctivitis – follicular

d.Urticaria

3. Punctate keratitis

4. Overgrowth of non-susceptible organisms

Local ophthalmic use or exposure – intracameral injection­

Certain

1. Uveitis

2. Corneal edema

3. Lens damage

Clinical significance

These drugs are not used parenterally because of nephroand ototoxicity. There are well-documented reports of decreased or absent pupillary reactions due to application of neomycin to the pleural or peritoneal cavities during a thoracic or abdominal operation.