Antibiotics

Most antibiotics can cause neuromuscular blockade in the absence of neuromuscular blocking drugs.^[466] The aminoglycoside group of antibiotics, such as polymyxins, lincomycin, and clindamycin, primarily inhibit the prejunctional release of acetylcholine and also depress postjunctional nAChR sensitivity to acetylcholine.^{[467] [468] [469]} Tetracyclines, on the other hand, exhibit postjunctional activity only.^{[468] [470] [471] [472]} When combined with neuromuscular blockers, the aforementioned antibiotics can potentiate neuromuscular blockade.^{[473] [474]} Cephalosporins and penicillins have not been reported to potentiate neuromuscular blockade. Antagonism of neuromuscular blockade has been reported to be more difficult after the administration of aminoglycosides.^{[475] [476]} Ventilation should be controlled until the neuromuscular blockade terminates spontaneously. Calcium should not be used to hasten recovery of neuromuscular function for two reasons: the antagonism that it produces is not sustained, and it may prevent the antibacterial effect of the antibiotic. Administration of 4-aminopyridine might be of value in these situations.^[474]