A few cases of worsening of myasthenic symptoms have been observed with the use of ampicillin 53 and other penicillins. Bacitracin may also worsen myasthenia, but the literature is confounded by the concomitant use of other antibiotics. 47 Polymyxins are considered to act both pre-and post-synaptically to produce or exacerbate myasthenia gravis. 25 Their action is reversed by the administration of diaminopyridine only. 47 Tetracycline and its analogues are reported to have weak neuromuscular blocking effects which usually are reversed by calcium, 47 and are thought to exacerbate myasthenia gravis. 23 , 25 There have been reports of worsening of myasthenia with the use of imipenem/cilastatin, 54 and with infusion of vancomycin. 55 The mechanism of action of these at the neuromuscular junction is not known.
The American College of Chest Physicians is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. With more than 19,000 members representing 100+ countries around the world, our mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. This includes connecting health-care professionals to the latest clinical research and a wide array of evidence-based guidelines through the CHEST Journal, while also serving as a total education resource for clinicians through year-round meetings, books, mobile apps, and live courses in pulmonary, critical care, and sleep medicine. The first medical association with a clinical simulation program accredited by the Society for Simulation in Healthcare, the American College of Chest Physicians also provides hands-on training through innovative simulation education. The CHEST Foundation, our philanthropic arm, provides members with grants, patient education tools, and other resources to help their patients live and breathe easier.