Do not avoid antibiotic use in patients with serious infections because of theoretical limitations
Do not avoid antibiotic use in patients with serious infections because of theoretical limitations: Excerpt from Avoiding Common Pediatric Errors
Author:
Yolanda Lewis-Ragland, MD
What to Do - Take Action
The American Academy of Pediatrician's evidence-based guidelines endorse
the use of cephalosporin antibiotics for patients with reported allergies to
penicillin for the treatment of acute bacterial sinusitis and acute otitis media.
Manyphysicians,however,remainreluctanttoprescribesuchagentsbecause
of a fear of cross-reactivity between the two drug classes. Although these
concerns are understandable, a lack of consistent data regarding exactly
what constitutes an initial penicillin-allergic reaction and subsequent cross-
sensitivity to cephalosporins may possibly prevent patients from receiving
optimal antibiotic therapy.
This topic is one of great importance because true allergic reactions
to penicillin can be extremely varied. Allergic responses occurring with a
penicillin allergy range from annoying rashes to life-threatening reactions,
such as difficulty anaphylaxis.
Signs and Symptoms of Penicillin Allergy
Common signs and symptoms of penicillin allergy include:
• Rash
• Hives
• Itchy eyes
• Swollen lips, tongue, or face (angioedema).
The most serious allergic reaction to penicillin, however, is anaphylaxis,
which has a high mortality if untreated. Anaphylactic reactions develop
immediately after penicillin exposure in highly sensitized people and cause
bronchoconstriction, hypotension, and loss of consciousness. Other serious
signs and symptoms include:
• Wheezing
• Lightheadedness
• Slurred speech
• Rapid or weak pulse
• Cyanosis, including circumoral and nail beds
• Diarrhea
• Nausea and vomiting.
Are Cephalosporins a Real Threat?
Cephalosporin antibiotics are important in infectious diseases and, like penicillins, are widely prescribed for common infections such as bronchitis, otitis
media,pneumonia,andcellulitis.Theyarealsoadministeredasfirst-lineprophylaxis for many types of surgical procedures. A relative contraindication
to these agents has been a history of allergy to penicillin. In this situation,
manyclinicianswouldselectadifferentclassofantibiotic,suchasamacrolide
or vancomycin. However, the emergence of antimicrobial-resistant organisms demands that the selection of antibiotics be made only after careful
evaluation.
Inlight ofthis, investigatorshaveperformedextensive studieswith both
experimental and clinical trials. The results indicate that if a cephalosporin
with a side chain that is different from the penicillin is used. The risk of
suffering an allergic reaction by administering cephalosporins to penicillin-
allergic patients is very low.
Suggested Readings
Mayo Foundation for Medical Education and Research. Penicillin Allergy. December 22, 2005.
Available at: www.cnn.com/HEALTH/library/DS/00620.html. Accessed November 14,
2007.
Novalbos A, Sastre J, Cuesta J, et al. Lack of allergic cross-reactivity to cephalosporins among
patients allergic to penicillins. Clin Exp Allergy. 2001;31(3):438–443.
Romano A, GuŽeant-Rodriquez R-M, Viola M, et al. Summaries for patients. Cephalosporin
allergy in patients with penicillin allergy. Ann Intern Med. 2004;141(1):I48.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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