Antibiotics in Myasthenia Gravis

Some antibiotics can reduce the effectiveness of neuromuscular transmission in a patient with Myasthenia Gravis (MG) and can exacerbate the symptoms of the disease.  The table below provides some information about which antibiotics are contraindicated in MG or are to be used with caution.

Please note that this is not a comprehensive list. Please check with Medicines Information (CGH ext 3030; GRH ext 6108) if any other antibiotics are required.

 

Amoxicillin

No information found to suggest a problem in myasthenia gravis.

Benzylpenicillin

No information found to suggest a problem in myasthenia gravis.

Ceftriaxone

No information found to suggest a problem in myasthenia gravis.

Ciprofloxacin

Fluoroquinolones should be avoided in patients with a history of myasthenia gravis. Neuromuscular blocking activity; may exacerbate muscle weakness.

Clarithromycin

Exacerbation of symptoms of myasthenia gravis has been reported in patients.

Clindamycin

Clindamycin has been shown to have neuromuscular blocking properties and may enhance the effect of other drugs with this action.

Co-amoxiclav (clavulanic acid & amoxicillin)

No information found to suggest a problem in myasthenia gravis.

Co-trimoxazole

Sulphonamides have a depressant effect on neuromuscular junction and may increase weakness.

Daptomycin

No information found to suggest a problem in myasthenia gravis.

Doxycycline

Due to a potential for weak neuromuscular blockade, care should be taken in administering tetracyclines to patients with myasthenia gravis.

Erythromycin

It has been reported that erythromycin may aggravate muscle weakness of patients with myasthenia gravis.

Flucloxacillin

No information found to suggest a problem in myasthenia gravis.

Fluconazole

No information found to suggest a problem in myasthenia gravis.

Gentamicin

Inhibits acetylcholine release from presynaptic neuron; also has some postsynaptic curare-like action. Avoid in patients with myasthenia gravis

Levofloxacin

Fluoroquinolones should be avoided in patients with a history of myasthenia gravis. Neuromuscular blocking activity; may exacerbate muscle weakness.

Linezolid

No information found to suggest a problem in myasthenia gravis.

Meropenem

No information found to suggest a problem in myasthenia gravis.

Metronidazole

No information found to suggest a problem in myasthenia gravis.

Micafungin

No information found to suggest a problem in myasthenia gravis.

Tazocin (tazobactam & piperacillin)

Neuromuscular blockade produced by muscle relaxants could be prolonged in the presence of piperacillin.

Teicoplanin

No information found to suggest a problem in myasthenia gravis.

Temocillin

No information found to suggest a problem in myasthenia gravis.

Tigecycline

Due to a potential for weak neuromuscular blockade, care should be taken in administering tetracyclines to patients with myasthenia gravis.

Tobramycin

Aminoglycosides may aggravate muscle weakness.

Trimethoprim

No information found to suggest a problem in myasthenia gravis.

Vancomycin

Concomitant use of vancomycin with muscle relaxants suxamethonium or vecuronium has been associated with the potential for enhanced neuromuscular blockade

Last Reviewed: 01/05/16