Seromycin Pulvules Disease Interactions

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

The use of cycloserine is contraindicated in patients with seizure disorders, depression, severe anxiety, dementia, psychoses, and alcoholism. Cycloserine is associated with a high incidence of dose-related central nervous system (CNS) toxicities, including confusion, disorientation, aggression, anxiety, psychoses, depression with suicidal tendencies, paresis, seizures, and coma. CNS effects may be more likely to occur with dosages greater than 500 mg/day, in chronic alcoholics, and during coadministration with ethionamide or isoniazid. Toxicity correlates with blood levels exceeding 30 mcg/mL.

The use of cycloserine is contraindicated in patients with severe renal impairment. Cycloserine is associated with a high incidence of neurotoxicities, which correlates with blood levels exceeding 30 mcg/mL. Since cycloserine is primarily eliminated by the kidney, patients with renal impairment may be more likely to experience toxicity due to inadequate drug clearance. Patients with reduced renal function should be monitored closely during therapy with cycloserine. Blood levels should be drawn weekly, and dosage adjusted accordingly.