Explore chapters and articles related to this topic
Skin Testing in Drug Hypersensitivity
Published in Kirsti Kauppinen, Kristiina Alanko, Matti Hannuksela, Howard Maibach, Skin Reactions to Drugs, 2020
In suspected immediate type allergy to penicillins and semisynthetic penicillins, skin testing is carried out initially by skin prick testing and, if negative, by ID testing.16–18 Benzylpenicilloyl polylysine (6 × 105 mol/L), benzylpenicillin minor determinant mixture containing penicillin, penicilloate, and penilloate (BP-MDM, 1 × 10−2 mol/L), ampicillin-MDM (1 × 10−2 mol/L), amoxicillin-MDM (1 × l0−2 mol/L), and cloxacillin-MDM (1 × 10−2 mol/L), prepared as proposed by Levine et al.,19 were used for skin testing in 112 patients with clearly defined historical allergic reactions to penicillin and its derivatives.17 A total of 21 out of 112 patients with historical penicillin allergy reacted positively to one or more of the allergens tested. Ten patients reacted to the side-chain allergens only, four to benzylpenicilloyl polylysine, four to BP-MDM, and three to both side-chain and benzylpenicillin allergens. The significance of the different reactivity patterns is not known.
SplenectomyFrom Prophylaxis to Treatment
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Additionally to vaccinations, patients will need a minimum of 2 years of antibiotic prophylaxis. Some guidelines advise lifelong continuous antibiotic prophylaxis. The most commonly used one is feneticilline 250 mg BD or 500 mg OD (adult doses). For patients with a penicillin allergy, alternatives could be clarithromycin/azithromycin, moxifloxacin or erythromycin.
Antibiotic Therapy in the Penicillin-Allergic Patient in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The incidence of penicillin allergy in the general population has been estimated to be 1%–10%, but no good reliable data exist on the actual incidence of penicillin allergy. Penicillin data derived from penicillin skin testing do not correlate with penicillin reactions in the clinical setting. Many patients reporting penicillin allergy have in fact had reactions to penicillin but not on an allergic basis and are of the non-anaphylactic or anaphylactic variety if they are indeed penicillin reactions. Penicillin reactions may occur after a single exposure to a penicillin or β-lactam antibiotic. From questioning or previous history, patients’ penicillin reactions may be classified as anaphylactic or non-anaphylactic. Because the cross-reactivity between β-lactams and penicillin is so low, β-lactam antibiotics may be used in patients who have had a drug fever or a drug rash. Should the patient have an allergic cross-reaction between the β-lactam and the penicillin, the allergic manifestation will be of the same type as experienced previously.
Prevention of prosthetic joint infection/surgical site infection: what did the International Consensus Meeting decide?
Published in Expert Review of Medical Devices, 2023
Farideh Najafi, Neusha Hollingsworth, Nicholas V Peterson, Javad Parvizi
The issue of perioperative antibiotics was also discussed thoroughly. It was agreed that administration of first-generation cephalosporins, such as cefazolin, within 30 minutes of surgical incision was a critical strategy for prevention of SSI/PJI [2–5]. The administration of cephalosporin to patients with non-anaphylactic penicillin allergy was also deemed to be appropriate. For patients with anaphylactic penicillin or cephalosporin allergies, vancomycin, teicoplanin, or clindamycin were thought to be appropriate substitutions [2]. Administration of vancomycin or teicoplanin, in addition to cephalosporin, was deemed to be appropriate for patients who are methicillin-resistant Staphylococcus aureus (MRSA) carriers, institutionalized patients (nursing home patients and those undergoing dialysis), healthcare workers, and those with recent MRSA infections [2]. It is stated that all antibiotics should be administered on a weight-based dosage [2,6]. It was recommended that a minimum of 2 g of cefazolin be used for patients >70 kg to achieve the minimum inhibitory concentration [2,6].
The democratization of de-labeling: a review of direct oral challenge in adults with low-risk penicillin allergy
Published in Expert Review of Anti-infective Therapy, 2020
Morgan Thomas Rose, Monica Slavin, Jason Trubiano
In a review of penicillin allergy evaluation without skin testing, Banks et al. described three cohorts of patients assessed using identical low-risk screening criteria. Low-risk was defined as a reaction occurring >1 year prior and described as (i) any benign rash, (ii) gastrointestinal symptoms, (iii) headaches, (iv) other benign somatic symptoms, (v) unknown history. All low-risk patients were given a single-dose direct oral challenge with amoxicillin (250 mg). 3 (1.1%) of 380 marine recruits developed immediate pruritus post-challengeNo (0%) immediate ADRs were reported in 283 adult patients challenged at Walter Reed National Medical Center2 (0.2%) immediate and 9 (1.1%) delayed ADRs were reported in a mixed cohort of 806 adult and pediatric patients. None was reported as serious although detailed descriptions were not provided [36].
Surgical management of severe facial trauma after dog bite: A case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Bernhard Prem, David Tianxiang Liu, Bernhard Parschalk, Boban M. Erovic, Christian A. Mueller
During the acute phase after a dog bite, another crucial aspect of treatment is anti-infective management with regards to rabies, tetanus and other bacteria [1,2,10]. Wound infections primarily exhibit a polymicrobial origin, with smear tests typically showing a mixture of aerobic and anaerobic bacteria from the dog’s oropharynx and the skin of the attacked human [2]. The most clinically important pathogens include Pasteurella spp., Capnocytophaga canimorsus, streptococci, staphylococci, Neisseria and anaerobic bacteria, such as Fusobacterium [1]. Pasteurella spp., particularly Pasteurella canis, is found in 50% of infections due to dog bites, and C. canimorsus can be isolated from up to 56% of all infections [2]. Authors recommend starting empiric antimicrobial therapy, even before receiving microbiological culture results, since dog bites are considered primarily infected [1,2]. Various published recommendations are largely similar, suggesting administration of amoxicillin–clavulanate for 7–10 days [1,2,19]. Therapeutic alternatives include doxycycline or clindamycin plus ciprofloxacin, for example, in cases of penicillin allergy [1]. After receiving the results of the microbiological culture, therapy should be adapted as needed.