Phenoxypenicillins
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Hypersensitivity reactions may occur in penicillin-sensitive patients. Pen V may be cross-allergenic with Pen G and also with all other penicillins, including both anaphylaxis and serum sickness. For a detailed discussion regarding penicillin allergy, see Chapter 3, Benzylpenicillin (Penicillin G). However, anaphylaxis is much less common with the oral Pen V than with parenteral Pen G. In one patient, symptoms started 30 minutes after ingestion of 500 mg of Pen V (Coates, 1963). In another patient, generalized pruritus and flushing commenced within 3 minutes of ingestion of a tablet of Pen V, followed by abdominal cramps, nausea, and vomiting, then progression to semiconsciousness, cyanosis, tachycardia, and hypotension; the patient finally responded to standard resuscitative measures (Simmonds et al., 1978). Beeley et al. (1976) reported one adult patient who developed liver damage with jaundice as part of a severe hypersensitivity reaction to Pen V.
Complications of Antibiotic Therapy
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The beta-lactam antibiotics (penicillins, cephalosporins, carbapenems, and the monobactam, aztreonam) can all cause the general adverse events listed earlier (anaphylaxis, cutaneous eruptions, drug fever, and the emergence of resistance). Patients tend to report that they have a “penicillin allergy,” although this is frequently a rash not associated with a serious allergic reaction such as anaphylaxis. Adverse reactions to penicillins can include anaphylaxis, urticaria, hemolytic anemia, and serum sickness, all of which are rare. IgE-mediated rash, as well as nonallergic rash, is relatively common. GI complications include diarrhea in 2%–5% of patients, and enterocolitis in <1% of patients. Penicillins can rarely cause seizures. Any penicillin drug can cause interstitial nephritis (<1%).24
Antibiotic Therapy in the Penicillin-Allergic Patient in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in 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.
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].
Alopecia syphilitica, from diagnosis to treatment
Published in Baylor University Medical Center Proceedings, 2022
Mojahed Mohammad K. Shalabi, Brooke Burgess, Samiya Khan, Eric Ehrsam, Amor Khachemoune
The drug of choice to treat all stages of syphilis is benzathine penicillin G. Because AS is a manifestation of secondary syphilis, the treatment follows the same guidelines as for secondary syphilis. Adults are given a single dose of 2.4 million units intramuscularly, while infants and children receive 50,000 units/kg with a limit of 2.4 million units in a single dose.15 For patients with documented penicillin allergy, alternatives include doxycycline 100 mg orally twice daily for 2 to 4 weeks or tetracycline 500 mg orally four times a day for 2 to 4 weeks.16 Tetracycline administration involves more frequent dosing and side effects such as nausea, vomiting, and diarrhea; therefore, compliance might be an issue. Limited clinical trials suggest that ceftriaxone 1 to 2 g intramuscularly or intravenously for 10 to 14 days has been effective in treating secondary syphilis.17 Patients with penicillin allergy who have issues with follow-up or compliance with medications should be desensitized and treated with benzathine penicillin.15
Iatrogenic factors of Helicobacter pylori eradication failure: lessons from the frontline
Published in Expert Review of Anti-infective Therapy, 2023
Jinliang Xie, Dingwei Liu, Jianxiang Peng, Shuang Wu, Dongsheng Liu, Yong Xie
The top three combinations of antibiotic agents were amoxicillin-furazolidone (33.0%,286/867), clarithromycin-nitroimidazole (18.1%, 157/867), and amoxicillin-clarithromycin (16.8%, 146/867) in Table 2. Also, 70 patients (13.8%, 70/508) used other regimens in 81 courses, including only one antibiotic (quinolone, furazolidone, amoxicillin, or nitroimidazole), not recommended antibiotics (clindamycin, roxithromycin, gentamicin, etc), non-high dose dual therapy or non-bismuth quadruple therapy. The most common antibiotic combination was clarithromycin–nitroimidazole (34.6%, 18/52) in the patients allergic to penicillin as shown in Supplemental Table 1. In the patients without a penicillin allergy, the top three combinations of antibiotic agents were amoxicillin-furazolidone (35.1%, 286/815), amoxicillin-clarithromycin (17.9%, 146/815), and clarithromycin-nitroimidazole (17.0%, 139/815) in Supplemental Table 2.
Related Knowledge Centers
- Antibiotic
- Benzathine Benzylpenicillin
- Benzylpenicillin
- Pathogenic Bacteria
- Side Effect
- Procaine Benzylpenicillin
- Phenoxymethylpenicillin
- Beta-Lactam Antibiotics
- Amoxicillin
- Allergist