From the Guidelines
Medical procedures can lead to various complications, including surgical site infections, bleeding, pulmonary complications, deep vein thrombosis, and cardiac arrhythmias, as highlighted in the study by 1. The complications of a medical procedure can be categorized into early and late complications. Early complications include:
- Surgical site infection (superficial, deep)
- Bleeding (gastrointestinal, intraperitoneal)
- Pulmonary complications (airway obstruction, atelectasis, pneumonia, pneumothorax, respiratory failure)
- Deep vein thrombosis and pulmonary embolism
- Nausea and vomiting, food intolerance, dehydration
- Prolonged postoperative ileus
- Cardiac arrhythmia (induced by hypoxia)
- Myocardial infarction
- Dehiscence and evisceration
- Rhabdomyolysis (due to pressure necrosis of the gluteal and shoulder muscles), acute tubular necrosis
- Pancreatitis
- Sepsis and multiple organ failure, as reported in the study by 1. In addition to these early complications, cardiac structural complications can also occur, including injury to the aortic annulus, left ventricle outflow tract, ventricular septum, left or right ventricle, atrial septum, left or right atrium, mitral valve apparatus, tricuspid valve apparatus, coronary artery, and coronary sinus, as defined by the Valve Academic Research Consortium 3 in the study by 1. It is essential to carefully evaluate the risks and benefits of a medical procedure and to closely monitor patients for potential complications, as emphasized by the findings of 1 and 1.
From the FDA Drug Label
- 1 Clinical Trials Experience ... Potentially serious adverse reactions of angioedema and cholestatic jaundice were reported.
- 2 Postmarketing Experience ... Adverse reactions reported with azithromycin during the postmarketing period in adult and/or pediatric patients for which a causal relationship may not be established include: Allergic: Arthralgia, edema, urticaria, and angioedema. Cardiovascular: Arrhythmias including ventricular tachycardia and hypotension. There have been reports of QT prolongation and torsades de pointes Gastrointestinal: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea, pseudomembranous colitis, pancreatitis, oral candidiasis, pyloric stenosis, and reports of tongue discoloration. General: Asthenia, paresthesia, fatigue, malaise, and anaphylaxis Genitourinary: Interstitial nephritis and acute renal failure and vaginitis. Hematopoietic: Thrombocytopenia Liver/Biliary: Abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis, and hepatic failure. Nervous System: Convulsions, dizziness/vertigo, headache, somnolence, hyperactivity, nervousness, agitation, and syncope. Psychiatric: Aggressive reaction and anxiety. Skin/Appendages: Pruritus serious skin reactions including erythema multiforme, Stevens-Johnson Syndrome, toxic epidermal necrolysis, and DRESS Special Senses: Hearing disturbances including hearing loss, deafness and/or tinnitus, and reports of taste/smell perversion and/or loss.
The complications of the medical procedure (azithromycin therapy) include:
- Allergic reactions: angioedema, arthralgia, edema, urticaria
- Cardiovascular events: arrhythmias, ventricular tachycardia, hypotension, QT prolongation, torsades de pointes
- Gastrointestinal issues: anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea, pseudomembranous colitis, pancreatitis
- General symptoms: asthenia, paresthesia, fatigue, malaise, anaphylaxis
- Genitourinary problems: interstitial nephritis, acute renal failure, vaginitis
- Hematopoietic disorders: thrombocytopenia
- Liver/Biliary issues: abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis, hepatic failure
- Nervous system problems: convulsions, dizziness/vertigo, headache, somnolence, hyperactivity, nervousness, agitation, syncope
- Psychiatric issues: aggressive reaction, anxiety
- Skin/Appendages reactions: pruritus, serious skin reactions including erythema multiforme, Stevens-Johnson Syndrome, toxic epidermal necrolysis, DRESS
- Special senses disturbances: hearing loss, deafness, tinnitus, taste/smell perversion, taste/smell loss 2
From the Research
Complications of Medical Procedures
The complications of medical procedures can be severe and life-threatening. Some of the potential complications include:
- Hypersensitivity reactions, which can range from mild to life-threatening anaphylaxis 3, 4, 5
- Anaphylaxis, which can occur in response to various medications, including neuromuscular blocking agents, latex, and antibiotics 3, 4, 5
- Allergic reactions to local anesthetics, which can be caused by hypersensitivity or toxicity 6
- Adverse reactions to drugs, which can be caused by allergic or non-allergic mechanisms 7
Causes of Complications
The causes of complications during medical procedures can be varied, including:
- Medications, such as neuromuscular blocking agents, latex, and antibiotics 3, 4, 5
- Local anesthetics, which can cause hypersensitivity or toxic reactions 6
- Drugs, such as penicillins, beta-lactam antibiotics, and sulfonamides, which can cause allergic reactions 7
- Cross-reacting agents, which can cause allergic reactions in susceptible patients 4
Prevention and Management
Prevention and management of complications during medical procedures are crucial, including:
- Preoperative evaluation and allergological assessment to identify patients at risk of allergic reactions 3
- Avoidance of cross-reacting agents and latex in susceptible patients 4
- Premedication with antihistamines and corticosteroids to reduce the severity of reactions 4
- Immediate treatment of allergic reactions with oxygen, intravenous fluids, epinephrine, and histamine blockers 7