Cytotoxic Antibiotics

Authored by Dr Gurvinder Rull, 19 Jan 2012

Reviewed by:
Dr Hannah Gronow, 19 Jan 2012

This article is for Medical Professionals

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful.

This page has been archived. It has not been updated since 19/01/2012. External links and references may no longer work.

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).

Further reading and references

  1. ; NICE Technology Appraisal, 2005

  2. ; Cardiac safety of liposomal anthracyclines. Oncologist. 2003

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

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