The most common are hypersensitivity reactions including skin rashes, urticaria, eosinophilia, fever, reactions resembling serum sickness and anaphylaxis.
There may be a positive response to the Coombs' test although haemolytic anaemia rarely occurs. Neutropenia and thrombocytopenia have occasionally been reported. Agranulocytosis has been associated rarely with some cephalosporins.
Bleeding complications related to hypoprothrombinaemia and/or platelet dysfunction have occured especially with cephalosporins and cephamycins having an N-methylthiotetrazole side-chain including: cefamandole, cefbuperazone, cefmenoxime, cefmetazole, cefonicid, cefoperazone, ceforanide, cefotetan, cefpiramide, latamoxef.
The presence of methylthiadiazolethiol side-chain, as in cefazolin or an N-methylthiotriazine ring, as in ceftriaxone, might also be associated with such bleeding disorders. Hypoprothrombinaemia which is usually reversible with vitamin K, was once thought to be due to an alteration in intestinal flora but interference with prothrombin synthesis now seems more likely.
Nephrotoxicity has been reported with Cefpodoxime proxetil although it is less toxic than cefaloridine. Acute renal tubular necrosis has followed excessive dosage and has also been associated with its use in older patients or those with pre-existing renal impairment, or when used with nephrotoxic drugs such as aminoglycosides. Acute interstitial nephritis is also a possibility as a manifestation of hypersensitivity.
Transient increases in liver enzyme values have been reported. Hepatitis and cholestatic jaundice have occurred rarely with some cephalosporins.
Convulsions and other signs of CNS toxicity have been associated with high doses, especially in patients with severe renal impairment.
Gastrointestinal adverse effects such as nausea, vomiting and diarrhoea have been reported rarely. Prolonged use may result in overgrowth of non-susceptible organisms and as with other broad-spectrum antibiotics, pseudomembranous colitis may develop.
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