Antibiotics

The analysis may begin with the complete medication list, antibiotic dose and timing, prescribing information, laboratory monitoring, and the chronology of any reported reaction or change in clinical condition. The expert can then examine whether a recognized interaction was relevant to the medications actually administered and whether the clinical record supports the claimed sequence. Because interaction mechanisms differ among drugs, pharmacology or pharmacy expertise may also be appropriate when the interaction itself is the principal issue.

Peripheral neuropathy can be relevant to claims involving certain antibiotics, and FDA has specifically warned about this risk with systemic fluoroquinolones. FDA labeling and safety communications warn that oral and injectable fluoroquinolones are associated with potentially serious and sometimes persistent nerve-related adverse effects, including peripheral neuropathy. An expert reviewing such a claim may examine the specific antibiotic, route, dose, treatment dates, onset and course of neurological symptoms, prescribing information, medical history, and alternative explanations. A neurologist may also be needed when diagnosis or neurological causation is disputed.

The technical question should drive expert selection. Infectious Diseases expertise may be important when the dispute concerns infection management and antibiotic selection. Pharmacology or Pharmacy may be more relevant to dosing, pharmacokinetics, interactions, or medication management. Medical Toxicology may be appropriate for toxicity or overdose questions, while Neurology may be appropriate when the claimed injury is neurological. One expert should not automatically be expected to cover all of these disciplines.