Saturday, April 18, 2020

antibiotics and myasthenia crisis

Q: Which of the following antibiotics can make myasthenia crisis worse?

A) fluoroquinolones 
B) cephalosporins

Answer: A

ICU physicians need to be vigilant about reflexly using some medications while dealing with myasthenia crisis patients. There are many surgical, medical, physiological and pharmacological etiologies to precipitate or make myasthenic crisis worse. It includes thymectomy itself which is considered a surgical cure for myasthenia gravis (MG). All such patients should be watched post-operatively in ICU. Other precipitating factors are pregnancy, childbirth, or when immunosuppressive drugs are on taper. 

 When it comes to drugs aminoglycosides, fluoroquinolones, erythromycin, azithromycin, beta-blockers, procainamide, quinidine, and magnesium have pronounced effects. Patients with a history of MG should not be on automated ICU electrolytes protocol to avoid magnesium infusion bt accident.




1. Gummi RR, Kukulka NA, Deroche CB, Govindarajan R. Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve 2019; 60:693. 

2. French DM, Bridges EP, Hoskins MC, et al. Myasthenic Crisis In Pregnancy. Clin Pract Cases Emerg Med 2017; 1:291.

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