Emergency physicians prescribe antibiotics on a daily basis, and except for concerns about allergies and selecting the right antibiotic for the right infection, little thought is given to other potential adverse effects. Although we occasionally see antibiotic-related side effects in the ED, such as drug-induced diarrhea, skin rashes, and GI upset, these adverse events are usually easily handled by simply stopping the antibiotic or choosing a different one. It's important to be cognizant of additional antibiotic-related adverse effects that may not be expected, and to recognize those that do not even make common sense to the intuitive mind.

Last month's column began a series of discussions on important, and universally underappreciated, adverse drug reactions to fluoroquinolone antibiotics that are relevant to the emergency physician. I noted some rather bizarre and totally unexpected complications to this class of antibiotics that has gained wide popularity. Many drugs of this class are prescribed with relative impunity, but a second cogitation is in order. While the majority of fluoroquinolones are well tolerated and have been proven to be excellent antimicrobials, some of the adverse reactions should be viewed as essential knowledge for emergency physicians. I am sure we have all seen most of them, but failing to relate the nonintuitive ones is likely quite common for us mere mortals.