Cytotoxic Antibiotics

Authored by , Reviewed by Dr Hannah Gronow | Last edited

This article is for Medical Professionals

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Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.

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Cytotoxic antibiotics are used very commonly and widely in many malignancies.

Bleomycin, daunorubicin, doxorubicin, dactinomycin, epirubicin, idarubicin, mitoxantrone and mitomycin.

Direct toxic action on cellular DNA.[1]

  • Solid tumours, eg bladder, gastric, pancreatic and oesophageal.
  • Acute leukaemias.
  • Lymphomas.
  • Breast cancer.
  • Ovarian cancer - doxorubicin (see National Institute for Health and Clinical Excellence (NICE) guidance).[2]
  • Metastatic germ cell tumours and non-Hodgkin's lymphoma - bleomycin.
  • Radiotherapy - some cytotoxic antibiotics can result in toxicity.
  • Irreversible cardiotoxicity - must be used cautiously in patients with previous cardiac illness.[3] (A liposomal formulation of doxorubicin is available which is associated with less cardiotoxicity.)
  • Liver impairment.
  • Skin reactions - especially with doxorubicin.
  • Myelosuppression - usually occurs at 2-4 weeks with complete recovery by eight weeks.[4] Rare with bleomycin, whereas mitomycin is associated with delayed myelosuppression.
  • Extravasation causes severe skin necrosis.
  • Excreted in bile; therefore, it is necessary to monitor bilirubin levels - if high, dose reduction is needed.
  • Associated with cardiac toxicity - this is rare and includes supraventricular tachycardia (SVT) and cardiomyopathies (related to dose).

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Further reading and references

  1. What are the different types of chemotherapy drugs?, American Cancer Society, Apr 2005

  2. Ovarian cancer (advanced) - paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan; NICE Technology Appraisal, 2005

  3. Safra T; Cardiac safety of liposomal anthracyclines. Oncologist. 2003

  4. Rang HP, Dale MM, Ritter JM and Moore PK. (2003) Pharmacology, 5th ed, Bath, Churchill Livingstone

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