Infectious mononucleosis ampicillin rash

Additional information on the remarkably high rash rate in patients with mononucleosis infectiosa and other lymphatic diseases is given in several recent publications (19 --21 ). In one of them it was found that 15 out of 17 children with infectious mononucleosis developed rash 5—10 days after the beginning of ampicillin therapy (19 ). Since highly purified ampicillin preparations without proteinaceous material are available, ampicillin polymer is now suspected to be at least partly responsible for the ampicillin rash. The polymer does have a weak stimulating action on lymphocytes. In circumstances of altered cell function, such as occur in infectious mononucle-... 

Non-specific itching rashes, e.g. sulphonamides, penicillins, ampicillin in infectious mononucleosis... 

Drugs can give diagnostic clues, e.g. ampicillin and amoxicillin causing rash in infectious mononucleosis — a diagnostic adverse effect, not a diagnostic test. 

Some workers have concluded from statistical evidence that the underlying disease affects the incidence of sensitization. In infectious mononucleosis the incidence of eruptions following ampicillin treatment is particularly high, and in salmonellosis ampicillin seems to cause rashes more often than it does in other infections. 

At present, the ampicillins must be regarded as the commonest cause of drug-induced maculopapular eruptions. Rashes develop in an average of 10% of patients treated with ampicillin. As already mentioned, the underlying disease, and possibly the dose as well, has an unmistakable influence on the frequency of rashes. Kennedy et al. (1963) found higher incidences in salmonellosis than in other bacterial infections. In infectious mononucleosis the incidence of rashes is said to be 90%-100%. 

Gabbert WR, Hopwood AH (1968) Ampicillin-induced rash in infectious mononucleosis. J Ky Med Ass 66 967... 

Parker CW, Thiel JA (1963) Studies in human penicillin allergy a comparison of various penicilloyl-polylysines. J Lab Clin Med 62 482 Parker CW, de Week AL, Kern M, Eisen HN (1962 a) The preparation and some properties of penicillenic acid derivatives relevant to penicillin hypersensitivity. J Exp Med 115 803 Parker CW, Shapiro J, Kern M, Eisen HN (1962 b) Hypersensitivity to penicillenic acid de-rivates in human beings with penicillin allergy. J Exp Med 115 821 Parry MF, Ball WD, Conde JE Jr (1963) Nafcillin nephritis. JAMA 225 178 Patel BM (1967) Skin rashes with infectious mononucleosis and ampicillin. Pediatrics 40 910... 

A retrospective study of children hospitalised at two tertiary medical centres in Israel with a diagnosis of acute infectious mononucleosis (AIM) secondary to Epstein-Barr virus was conducted to determine the incidence of rash after receipt of various antibiotics. A total of 173 patients were identified as having received antibiotics and 65 did not. Of those who received antibiotics, 57/173 (32.9%) developed a rash compared to 15/65 (23.1%) in the nonantibiotic group. The incidence of rash was significantly higher among patients who had received amoxicillin (29.5%) compared to penicillin, amoxicillin/clavulanate, cephalosporins and macrolides. The authors noted that the incidence of amoxicillin-related rash in children with AIM was lower than the previously reported incidence of rash in children with AIM treated with ampicillin of 90% [32< ]. 

Amoxycillin differs only in one hydroxyl group from ampicillin. It is absorbed about twice as efficiently as the latter antibiotic. Evidence is accumulating that the incidence of skin eruptions is about half that reported for ampicillin (28 —31 ). The overall incidence of skin rash and/or urticaria reported in studies involving over 4000 patients has been 3% (29 ). It is also obvious from the literature cited here that the incidence of diarrhoea with amoxycillin (2—4%) is lower than with ampicillin (11%) (SED VllI, p. 563). However, a very recent report does describe a case in which a typical (and histologically verified) pseudomembranous colitis occurred in a boy aged 10 shortly after a brief course of treatment with amoxycillin (250 mg 3 times daily). No other apparent causal factor was in evidence (80 ). Two cases have been described of rash after amoxycillin in patients with infectious mononucleosis (32 ). 

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