A nurse is educating a patient about the adverse effects of antimicrobial therapy.
Which of the following statements by the patient indicate a need for further teaching? (Select all that apply.)

A red man syndrome is a reaction to the antibiotic vancomycin that causes flushing, itching, and sometimes hypotension and tachycardia. It is not a true allergic reaction, but rather a pseudoallergic or anaphylactoid reaction caused by the release of histamine from mast cells. It is more likely to occur when vancomycin is infused rapidly or at high doses.The symptoms usually resolve with slowing or stopping the infusion, and can be prevented by premedicating with antihistamines or extending the infusion time

Choice A is wrong because an allergic reaction to vancomycin would involve IgE-mediated hypersensitivity, which can cause urticaria, angioedema, bronchospasm, and anaphylaxis.An allergic reaction would not be dependent on the infusion rate or dose of vancomycin, and would require immediate discontinuation of the drug and treatment with epinephrine and other supportive measures

Choice B is wrong because a superinfection is a secondary infection that occurs when the normal flora of the body is disrupted by antibiotics, allowing opportunistic pathogens to proliferate. Common examples of superinfections are Clostridioides difficile colitis, oral or vaginal candidiasis, and methicillin-resistant Staphylococcus aureus infections. Superinfections do not cause flushing or itching, but rather symptoms related to the site of infection, such as diarrhea, abdominal pain, oral thrush, or skin lesions.Superinfections may require treatment with different antibiotics or antifungals

Choice C is wrong because a disulfiram-like reaction is a reaction that occurs when alcohol is consumed while taking certain drugs that inhibit the enzyme acetaldehyde dehydrogenase, which is responsible for metabolizing alcohol. This leads to the accumulation of acetaldehyde, which causes nausea, vomiting, headache, flushing, palpitations, and hypotension. Vancomycin does not cause a disulfiram-like reaction, but some other antibiotics such as metronidazole and cephalosporins do.A disulfiram-like reaction can be avoided by abstaining from alcohol while taking these drugs

The correct answer is choice D and E and they indicate a need for further teaching.

Choice D is wrong because the patient should not stop taking the medication if they develop a rash or hives, but should report it to the provider immediately, as this could indicate a serious allergic reaction.

Choice E is wrong because the patient should not take an antacid if they have stomach upset, as this could interfere with the absorption of the antimicrobial drug.

Some additional information:

• Choice A is correct because drinking plenty of fluids can help prevent kidney damage from some antimicrobial drugs, such as aminoglycosides.

• Choice B is correct because ringing in the ears or hearing loss can be signs of ototoxicity from some antimicrobial drugs, such as vancomycin.

• Choice C is correct because some antimicrobial drugs, such as tetracyclines and sulfonamides, can increase the sensitivity to sunlight and cause sunburns.

• Normal ranges for kidney function tests are blood urea nitrogen (BUN) 7 to 20 mg/dL and creatinine 0.6 to 1.2 mg/dL.

• Normal ranges for liver function tests are alanine aminotransferase (ALT) 7 to 56 units/L and aspartate aminotransferase (AST) 10 to 40 units/L.