Antibiotics anaphylaxis

Rifamycin SV (rINN), a semisynthetic macrocyclic antibiotic derived from natural rifamycin B, has been used in the therapy of tuberculosis and in some European countries as a topical antibiotic. Anaphylaxis has been reported after systemic administration, and rarely after topical application. 

Type I IgE Anaphylaxis, urticaria P-Lactam antibiotics penicillins (primarily), cephalosporins, carbapenems Non-fl-lactam antibiotics sulfonamides, vancomycin Others insulin, heparin... 

Hypersensitivity reactions with P-lactam antibiotics, especially penicillin, may encompass any of the type I through IV Gell-Coombs classifications. The most common reactions are maculopapular and urticarial eruptions.7 While rare (less than 0.05%), anaphylaxis to penicillins causes the greatest concern because they are responsible for the majority of drug-induced anaphylaxis deaths in patients, accounting for 75% of all ana-i phylaxis cases in the United States.5,8 The treatment of ana-I phylaxis is given in Table 51-2.9... 

Antibiotics Cephalosporins Chloramphenicol Neomycin Sulfathiazole Spiramycin Quinolones Tetracyclines Hypersensitivity Anaphylaxis, urticaria, rash, granulocytopenia Rash, dermatitis, urticaria Dermal exposure-rash, dermatitis Rash, dermatitis, urticaria Rash, dermatitis, urticaria Photosensitivity Photosensitivity, anaphylaxis, asthma, dermatitis... 

Antibiotics Isoniazid Penicillins Hypersensitivity and Autoimmunity Rash, dermatitis, vasculitis, arthritis, drug-induced SLE Anaphylaxis, dermatitis vasculitis, serum sickness, hemolytic anemia... 

Un, acute exacerbation of chronic bronchitis prophylaxis in transurethral procedures Action Quinolone antibiotic -1- DNA gyrase. Dose 400 mg/d PO X w/ renal insuff, avoid antacids Caution [C, —] Interactions w/ cation-containing products Contra Quinolone all gy, children <18 y,T QT interval, X Disp Tabs SE NA/ /D, abd pain, photosens, Szs, HA, dizziness, tendon rupture, periph al neuropathy, pseudomembranous cohtis, anaphylaxis Interactions t Effects W/ cimetidine, probenecid T effects OF cyclosporine, warfarin, caffeine X effects W/ antacids EMS Monitor ECG for TqT int val, esp in pts taking class lA/III antiarrhythmics monitor ECG and BP for signs of h5 povolemia and electrol5rte disturbances (hypokalemia) d/t D T risk of photosensitivity Rxns OD May cause NA /D, confusion and Szs symptomatic and supportive... 

Spectinomycin is a particularly valuable antibiotic because of its low toxicity. It may cause hepatic, renal, and hematological disturbances. Anaphylaxis has rarely been reported. 

A retrospective analysis of allergic reactions (drug-induced fever and rash) in 90 adults with cystic fibrosis, of whom 26 developed probable allergic reactions to parenteral beta-lactams. There was drug-induced fever in 54 and skin reactions in 28 of 897 treatment courses (6 and 3.1% respectively). There was one case of non-fatal anaphylaxis. The numbers of allergic reactions per number of patients receiving specific antibiotics were carbenicillin 4/56, mezlocillin 7/42, piperacillin 11/31, ticarcUlin 1/20, cefazolin 0/24, ceftazidime 1/35, imipenem + cilastatin 4/16, and nafcillin 3/36 (17). 

The main lesson from this case is that a small amount of a beta-lactam antibiotic anywhere in the body can cause life-threatening anaphylaxis. 

Quadruple therapy (omeprazole, amoxicUhn, roxithromycin, and metronidazole for 1 week) has been studied in an open trial in 169 patients with H. pylori (8). This regimen achieved an eradication rate of 92%. It was also beneficial in patients infected with pretreatment resistant strains to the antibiotics, in which cases the eradication rates achieved (over 90%) were similar to eradication rates in patients infected with sensitive strains. Compliance was good and there was only one serious adverse effect, anaphylaxis, probably due to amoxicillin. Frequent adverse effects were abdominal distension (10%), glossitis (9%), and diarrhea (8%). 

Penicillins should be avoided in any patient who gives a history of a skin reaction or anaphylaxis to any penicillin derivative. To prevent mild skin reactions becoming severe when they occur, it is advisable to withdraw the culprit antibiotic not only when a type I reaction is suspected but in aU kinds of common rashes, in view of a possible epider-moljdic process. A diet free of dairy products was curative in 30 of 70 patients with positive tests (170). 

Procedure Beta-lactam desensitization should be done in an intensive care unit and any concomitant risk factors for anaphylaxis, such as use of beta-blockers should be corrected. Protocols based on incremental use of the drug orally or parenterally have been described (190,193). The oral route is preferable and is associated with a lower incidence of adverse events, but mild transient reactions are frequent (171,194,195). Pregnant women with limited antibiotic choices have been treated with immunotherapy (196). Repeated administration will maintain a state of anergy, which is often lost after withdrawal (197). At the conclusion of therapy, patients must be informed that after withdrawal, they may once again become allergic to penicillin, with a new reaction to the first subsequent application (197). 

Hoffman DR, Hudson P, Carlyle SJ, Massello W 3rd. Three cases of fatal anaphylaxis to antibiotics in patients with prior histories of allergy to the drug. Ann Allergy 1989 62(2) 91-3. 

In some patients the clinical presentation of red man syndrome is identical to that of acute IgE-mediated anaphylaxis. Vancomycin desensitization should therefore be considered for severe red man syndrome reactions that do not respond to premedication and a slower rate of infusion, and in anaphylactic reactions to vancomycin when substitution of another antibiotic is not feasible. Rapid desensitization is preferred, as it is effective in the majority of patients and enables administration of vancomycin within 24 hours. In patients who fail rapid desensitization, a slow desensitization protocol may be tried (90). 

Chopra N, Oppenheimer J, Derimanov GS, Fine PL. Vancomycin anaphylaxis and snccessfnl desensitization in a patient with end stage renal disease on hemodialysis by maintaining steady antibiotic levels. Ann Allergy Asthma Immunol 2000 84(6) 633-5. 

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