Antimicrobial allergic reactions

Every patient receiving antimicrobial therapy for skin and soft tissue infections must be monitored for efficacy and safety. Efficacy typically is manifested by reductions in temperature, white blood cell count, erythema, edema, and pain that begin within 48 to 72 hours. To ensure safety, dose antibiotics according to renal and hepatic function as appropriate, and monitor for and minimize adverse drug reactions, allergic reactions, and drug interactions. 

P-Lactam allergy Refers to patients who experience allergic reactions to the P-lactam class of antimicrobials. 

Relative contraindications to sulfonamides are systemic lupus erythematosus and a known predisposition to lupuslike reactions. Allergic reactions to antimicrobials are frequent in patients with Sjogren s sjmdrome. They are especially susceptible to reactions to penidUins, cephalosporins, and sulfonamides, but reactions to macrohdes and tetracyclines also seem to be over-represented in these patients (210). 

Does patient have a clinically significant allergic reaction to any antimicrobial agent ... 

In a survey of cosmetic allergy Schorr (1971) mentioned other cosmetic preservatives and antimicrobial agents betaines, miranols (amphoteric), dimethoxane (Dioxin), and dehydroacetic acid. How often they produce allergic reactions is unknown only a few have been reported. Dimethoxane (1.25%) sensitized 50 of 205 subjects in a Draize test (Maibach 1971). 

Patch-test concentrations for all three compounds are greater than 0.01% aqua (phenylmercuric acetate is also patch tested at 0.05% aqua). Allergic reactions are uncommon, but contact urticaria was reported (Torre-sani et al. 1993) In antimicrobial concentrations (0.1-2%) they are considered irritant. 

Triclocarban (TCC, trichlorocarbanilide, Cutisan, Nobacter, Solubacter, CAS no. 101-20-2). This is an antiseptic and bacteriostatic used in antimicrobial soap bars, deodorants, antiperspirants. Photoallergic and phototoxic reactions were reported (Hasan and Jansen 1996). Cross reaction occurs with other halogenated salicylanilides. Caustic reaction on skin and mucosa was reported (Barriere 1973). Allergic reactions are not uncommon, and can result in pigmentation afterwards. The patch-test concentration is 2% pet. 

Phenylethanol alone is not routinely used as preservative in eye drops due to too low an antimicrobial activity especially against gram-positive bacteria. Moreover phenylethanol cannot be combined with other preservatives because of its potential to irritate the eye [101]. Hydroxybenzoic esters are also reported to cause a high incidence of eye irritation. Thiomersal is not routinely used due to low antimicrobial activity, allergic reactions and penetration of mercury into the eye. The same is also true but to a much lesser extent for phenylmercuric salts [102-104] (see also Sect. 23.8.4). 

Propyl parahydroxybenzoate 0.3 mg/mL Antimicrobial activity at pH 4-8, decreasing with increasing pH [5] Allergic reactions... 

For both the clinician and patient, an allergic reaction elicited by a p-lactam antibiotic is probably considered the archetypal drug allergy but a range of other antibiotics, both naturally occurring and semisynthetic, and a number of other antimicrobials of varied origin and nature also... 

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