Background: Due to the high prevalence of severe infections, antibiotics are frequently administered in anaesthesia and intensive care units. Despite their therapeutic efficacy, several antibiotics exhibit neurotoxic potential, resulting in central and peripheral neurological complications in patients. This review aims to summarise the current evidence on antibiotic-induced neurotoxicity, particularly in critical care settings. Methods: A comprehensive literature analysis was performed to assess the neurotoxic profiles, underlying mechanisms, and clinical manifestations associated with different antibiotic classes, including beta-lactams, fluoroquinolones, macrolides, aminoglycosides, and others. Results: Beta-lactam antibiotics (especially cephalosporins and carbapenems) are strongly associated with seizures, encephalopathy, and EEG abnormalities, mainly through GABAergic inhibition and mitochondrial dysfunction. Fluoroquinolones and macrolides can cause psychosis, insomnia, and neuropathy via NMDA activation and oxidative stress. Linezolid carries the risk of serotonin syndrome and optic neuropathy, while glycopeptides and aminoglycosides are primarily associated with ototoxicity. Risk factors include advanced age, renal or hepatic impairment, and high serum drug levels. Conclusions: The neurotoxic potential of antibiotics is a critical but under-recognised aspect of pharmacotherapy in intensive care. Improved awareness, pharmacovigilance, dose adjustment, and drug monitoring are crucial for mitigating adverse neurological effects.

The rapid global spread of antimicrobial resistance (AMR) has significantly reduced the effectiveness of many modern antibiotics, creating an urgent need for alternative therapeutic strategies. One promising approach is the revival and repurposing of older antimicrobial agents whose clinical potential was previously limited by toxicity concerns, pharmacokinetic challenges, or the availability of newer drugs. Recent advances in drug delivery, dosing optimization, and antimicrobial stewardship have renewed interest in these compounds as viable options for the treatment of multidrug-resistant infections. The aim of this review is to provide a comparative, clinically oriented analysis of selected “old” antibiotics, fosfomycin, colistin, streptomycin, and vancomycin, with emphasis on their current therapeutic roles, pharmacokinetic/pharmacodynamic (PK/PD) targets, toxicity mitigation strategies, resistance mechanisms, and evidence supporting combination therapies and alternative routes of administration. This narrative review was conducted using a structured PubMed search and manual reference screening, focusing on clinical, PK/PD, and translational studies relevant to the contemporary use of legacy antibiotics. The review summarises current evidence on the re-emerging clinical applications of these agents, each discussed in the context of historical use, mechanism of action, resistance patterns, and newly identified indications. Attention is given to novel formulations, combination strategies, and alternative routes of administration that enhance efficacy while limiting toxicity, including applications in biofilm-associated infections. Overall, strategic repurposing of older antibiotics represents a valuable complementary approach in the fight against AMR and may extend the therapeutic lifespan of existing agents in an era of limited antibiotic innovation.

Tetanus is an infectious disease caused by the spore-forming bacterium Clostridium tetani, whose spores are commonly found in soil. Owing to the widespread implementation of vaccination programs, the incidence of tetanus has significantly declined; however, given the frequency of traumatic injuries and the environmental ubiquity of the pathogen, continued vigilance remains essential. The pathogenesis of the disease is primarily mediated by potent neurotoxins produced by the bacterium, particularly tetanospasmin. The hallmark clinical manifestations include generalized muscle spasms, which may progress to severe complications such as respiratory failure and death. Post-exposure management requires careful assessment of an individual’s risk of developing tetanus in order to guide appropriate therapeutic strategies. In confirmed cases, treatment typically involves antimicrobial therapy, administration of tetanus-specific immunoglobulin, and supportive symptomatic care. The differential diagnosis should include conditions such as strychnine poisoning, viral encephalitis, oropharyngeal disorders, and rabies.

Streszczenie Przedmiot badań Przedmiotem opracowania jest sugammadeks (SGM)- sól oktasodowa będąca pochodną γ-cyklodekstryny, która zrewolucjonizowała proces odwracania blokady nerwowo-mięśniowej (neuromuscular blockade, NMB) w nowoczesnej anestezjologii. Analizie poddano specyficzną budowę chemiczną leku, która umożliwia selektywne wiązanie środków blokujących złącze nerwowo-mięśniowe (neuromuscular blocking agents, NMBA), takich jak rokuronium i wekuronium, w stabilne kompleksy inkluzyjne. Praca koncentruje się na farmakokinetyce i farmakodynamice preparatu, a także na jego profilu bezpieczeństwa w porównaniu do tradycyjnie stosowanej neostygminy. Ważnym elementem badań jest również kontekst rynkowy związany z wygaśnięciem ochrony patentowej SGM w 2023 roku, co umożliwiło wprowadzenie na polski rynek tańszych odpowiedników generycznych. Cel badań Głównym celem artykułu jest usystematyzowanie współczesnej wiedzy medycznej na temat stosowania SGM w rutynowej praktyce klinicznej oraz w populacjach pacjentów o szczególnym ryzyku. Praca ma na celu wykazanie przewagi SGM nad inhibitorami acetylocholinoesterazy w zakresie szybkości i przewidywalności powrotu sprawności nerwowo-mięśniowej. Analizie poddano optymalizację dawkowania u pacjentów otyłych w oparciu o całkowitą masę ciała (total body weight, TBW), dzieci, seniorów, chorych z niewydolnością nerek czy miastenią. Dodatkowym celem jest ocena zasadności szerokiego wdrożenia leku jako standardu postępowania, biorąc pod uwagę gwałtowny spadek kosztów terapii. Materiały i metody Artykuł stanowi przegląd literatury naukowej z lat 2016–2026, uzupełniony o pojedyncze starsze źródła. Proces selekcji materiałów przeprowadzono w oparciu o bazy danych PubMed oraz Google Scholar, stosując polskie i angielskie słowa kluczowe „sugammadeks”, „generyki”, „anestezjologia”, „intensywna terapia”, „działania niepożądane”, „farmakoekonomika”. Wyniki Analiza wykazała, że SGM charakteryzuje się 100% biodostępnością po podaniu dożylnym i minimalnym metabolizmem, będąc wydalanym głównie przez nerki. Średni czas powrotu stosunku TOF (train-of-four) do wartości >0,9 po podaniu rokuronium wynosi od 1,4 do 1,5 minuty, co jest wynikiem nieosiągalnym dla neostygminy. U dzieci stosowanie SGM wiąże się ze znacznym skróceniem czasu do ekstubacji oraz mniejszą częstością występowania nudności i wymiotów pooperacyjnych (postoperative nausea and vomiting, PONV). W stanach nagłych typu „nie można intubować, nie można wentylować” (cannot intubate, cannot ventilate, CICV) podanie wysokiej dawki leku (16 mg/kg) może zapobiec konieczności udrażniania dróg oddechowych metodą FONA (front-of-neck airway). Badania potwierdziły, że wprowadzenie preparatów generycznych obniżyło cenę leku z poziomu około 6710 PLN do około 1545 PLN za opakowanie zbiorcze. Odnotowano rzadkie działania niepożądane, takie jak bradykardia czy anafilaksja (1 na 6000-14000 podań). Wnioski SGM stanowi obecnie najbezpieczniejszy i najskuteczniejszy środek odwracający NMB, oferując wyraźną przewagę kliniczną nad neostygminą dzięki brakowi działań muskarynowych. Wygaśnięcie ochrony patentowej i pojawienie się tanich generyków usunęło główną barierę ekonomiczną, co czyni ten lek dostępnym dla rutynowego stosowania. Powszechne wdrażanie SGM pozwala na optymalizację pracy bloków operacyjnych, skrócenie czasu rekonwalescencji pacjentów oraz istotne zmniejszenie ryzyka powikłań płucnych wynikających z resztkowego zwiotczenia. Pomimo rozwoju nowych cząsteczek, takich jak adamagammadeks czy kukurbituryle, SGM pozostaje fundamentem nowoczesnej i bezpiecznej anestezjologii.

Background: Cisatracurium is a non-depolarizing neuromuscular blocking agent (NMBA) with an intermediate duration of action, used both in anesthesia and in intensive care units. Its elimination primarily occurs via Hofmann elimination, making it independent of liver and kidney function. Cisatracurium has approximately three times greater neuromuscular blocking potency and a more favorable hemodynamic profile than atracurium. Despite these advantages, cisatracurium is not the first choice for procedures requiring rapid endotracheal intubation due to its relatively long onset time.Aim of the study: The aim of this study was to discuss the role of cisatracurium in anesthesia, compare its properties with those of other muscle relaxants, and identify its advantages and limitations.Material and methods: A literature review was performed involving a search for original studies in PubMed and Google Scholar published between 1995 and 2024.Results: Thirteen clinical studies met the inclusion criteria. Cisatracurium demonstrated a stable hemodynamic profile, predictable neuromuscular blockade, and favorable safety characteristics. Effective intubation conditions were most commonly achieved with doses of 0.2–0.3 mg/kg. Elderly patients exhibited a prolonged onset and duration of action. Compared with rocuronium-based regimens, cisatracurium combined with neostigmine was associated with slower recovery and a higher incidence of some postoperative pulmonary complications.Conclusions: Cisatracurium is an effective and safe muscle relaxant, particularly in situations requiring hemodynamic stability. Its Hofmann elimination makes it suitable for use in patients with renal and hepatic failure. However, its delayed onset of action limits its use in procedures requiring rapid intubation. Further studies are needed to evaluate the effects of cisatracurium on postoperative complications and its role in specific patient groups.

BACKGROUND The most common vascular lesions of the liver are hepatic hemangiomas (HH), which are generally asymptomatic and do not require medical intervention. However, when the lesions are large or multiple, they can be a significant clinical problem. This report describes a unique case of an elderly patient with isolated hepatic hemangiomatosis associated with the onset of consumptive coagulopathy and hemolytic anemia, ultimately resulting in liver failure and death. CASE REPORT A 74-year-old man presented with jaundice, progressive weight loss, fatigue, lower-limb edema, and recurrent epistaxis. Laboratory findings revealed normocytic anemia, thrombocytopenia, hyperbilirubinemia, hypoalbuminemia, and elevated liver enzymes. Abdominal ultrasound (US) and computed tomography (CT) demonstrated hepatomegaly with multiple hypoechoic and hypodense focal lesions, initially raising suspicion of metastatic disease. Colonoscopy and upper gastrointestinal endoscopy showed no evidence of malignancy. A core-needle biopsy of the hepatic lesions, complemented by positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI), confirmed the benign nature of the lesions, consistent with isolated hepatic hemangiomatosis. The patient was managed symptomatically and discharged home with recommendations for continued outpatient monitoring and urgent consultation in the event of any clinical deterioration. Unfortunately, after 3 months of relative symptoms improvement, he developed gastrointestinal bleeding and acute liver failure, which ultimately resulted in his death. CONCLUSIONS Hepatic vascular lesions are diagnostically challenging; definitive diagnosis requires correlation of clinical, imaging, and histopathological findings, as well as multidisciplinary consultation. The clinical course of hepatic hemangiomatosis ranges from benign to life-threatening, with potential complications such as hepatic failure or coagulopathy.