Macrolide allergy

Broad intravenous antibiotic coverage for the encapsulated organisms can include ceftriaxone or cefotaxime. For patients with true cephalosporin allergy, clindamycin may be used. If staphylococcal infection is suspected owing to previous history or the patient appears acutely ill, vancomycin should be initiated. Macrolide antibiotics, such as erythromycin and azithromycin, may be initiated if Mycoplasma pneumonia is suspected. While the patient is receiving broad-spectrum antibiotics, their regular use of penicillin for prophylaxis can be suspended. Fever should be controlled with acetaminophen or ibuprofen. Because of the risk of dehydration during infection with fever, increased fluid may be needed.6,27... 

As such, patients with penicillin allergies should be treated with a first-generation cephalosporin (if non-type I allergy), a macrolide/azalide, or clindamycin. Recurrent infections caused by reinfection, poor adherence to therapy, or true penicillin failure can be treated with amoxicillin-clavulanate, clindamycin, or penicillin G benzathine.45... 

Davies, R.X and Pepys, X (1975). Asthma due to inhaled chemical agents—The macrolide antibiotic spiramycin. Clin. Allergy 5 99-107. 

PCN-sensitive staph) Action Bact icidal -1- cell wall synth Spectrum Most gram(+), including str Dose Adults. 250-500 mg PO q6h, q8h, q 12h Peds. 25-50 mg/kg/25h PO in 4 doses -1- in renal impair on empty stomach Caution [B, M] Contra Allergy Disp Tabs, susp SE GI upset, int stitial nephritis, anaphylaxis, convulsions Interactions -1- Effects W/ ASA, probenecid t effects OF MTX t risk of anaphylaxes W/BB -1- effects W/ chloramphenicol, macrolides, tetracyclines X effects OF OCPs EMS Monitor for sup Infxn T effects of anticoagulants monitor for signs of electrol5rte disturbances and h5 povolemia d/t D OD May cause N/D and Szs activated charcoal may be effective... 

Hatipoglu U, Rubinstein I. Low-dose, long-term macrolide therapy in asthma an overview. Clin Mol Allergy 2004 Mar 16 2(1) 4. 

Uses Infxns of resp tract, skin/soft tissue, scarlet fever, syphilis Action Bactericidal X cell wall synth Dose Adults. 0.6—4.8 million Units/d in - doses ql2-24h give probenecid at least 30 min prior to PCN to prolong action Peds. 25,000-50,000 Units/kg/d EM - daily-bid Caution [B, M] Contra Allergy Disp Inj SE Pain at inj site, interstitial nephritis, anaphylaxis Interactions T Effects W/ probenecid T penicillin 1/2-life W/ ASA, furosemide, indomethacin, sulfonamides, thiazide diuretics T risk of bleeding W/ anticoagulants X effects W/ chloramphenicol, macrolides, tetracyclines X effects OF OCPs EMS See Penicillin G, Aqueous OD See Penicillin G, Aqueous... 

Johnston SL Macrolide antibiotics and asthma treatment. J Allergy Clin Immunol 2006 117 1233-1236. 

Pharyngitis, scarlet fever, erysipelas, and cellulitis caused by S. pyogenes and pneumonia caused by S. pneumoniae respond to macrolides. They are valuable alternatives for treatment of patients who have a serious allergy to penicillin. Unfortunately, macrolide-resistant strains are increasingly encountered. Penicillin-resistant strains of S. pneumoniae also are very likely to be resistant to macrolides. 

Panhans-Gross, A., Novak, N., Kraft, S., and Bieber, T. (2001). Human epidermal Langerhans cells are targets for the immunosuppressive macrolide tacrolimus (FK506). J. Allergy Clin. Immunol. 107, 345-352. 

Konno, S., Asano, K., Kurokawa, M., Ikeda, K., Okamoto, K., and Adachi, K. (1994). Antiasthmatic activity of a macrolide antibiotic, roxithromycin Analysis of possible mechanisms in vitro and in vivo. Int. Arch. Allergy Immunol. 105, 308-316. 

The macrolides are valuable alternatives for treatment of patients who have a serious allergy to penicillin. Unfortunately, macrolide-resistant strains are increasingly encountered. 

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