Penicillin hypersensitivity

The answer is b. (Hardman, p 1077.) Oxacillin is classified as a penicillinase-resistant penicillin that is relatively acid-stable and, therefore, is useful for oral administration. Major adverse reactions include penicillin hypersensitivity and interstitial nephritis. With the exception of methi-cillin, which is 35% bound to serum proteins, all penicillinase-resistant penicillins are highly bound to plasma proteins. Oxacillin has a very narrow spectrum and is used primarily as an anti staphylococcal agent... 

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

Cross-allergenicity with cephalosporins Individuals with a history of penicillin hypersensitivity have experienced severe reactions when treated with a cephalosporin. The incidence of cross-allergenicity between penicillins and cephalosporins is estimated to range from 5% to 16% however, it is possible the incidence is much lower, possibly 3% to 7%. 

There have been reports of individuals with a history of penicillin hypersensitivity who have experienced severe hypersensitivity reactions when treated with other -lactams. 

Erythromycin is effective in the treatment and prevention of S. pyogenes and other streptococcal infections, but not those caused by the more resistant fecal streptococci. Staphylococci are generally susceptible to erythromycin, so this antibiotic is a suitable alternative drug for the penicillin-hypersensitive individual. It is a second-line drug for the treatment of gonorrhea and syphilis. Although erythromycin is popular for the treatment of middle ear and sinus infections, including H. influenzae, possible erythromycin-resistant S. pneumoniae is a concern. 

Contraindications History of anaphylactic reaction to penicillins, hypersensitivity to cephalosporins... 

Other agents which contain the p-lactam ring include aztreonam and the carbapenems. Aztreonam is an unusual p-lactam for two reasons its antibacterial activity is exclusively Gram-negative and it is reported to carry very low risk of anaphylaxis in individuals who are penicillin-hypersensitive. 

One of the primary problems with penicillin drugs is the potential for allergic reactions.65 Hypersensitivity to penicillin is exhibited by skin rashes, hives, itching, and difficult breathing. In some individuals, these reactions may be minor and can often be resolved by changing the type of penicillin or the method of administration. In others, however, penicillin hypersensitivity may be severe and lead to an anaphylactic reaction (severe bronchoconstriction and cardiovascular collapse). 

In some patients, cephalosporins may cause an allergic reaction similar to the penicillin hypersensitivity described previously. A cross-sensitivity often exists a patient who is allergic to penicillin drugs will also display hypersensitivity to cephalosporin agents. Other principal adverse effects of cephalosporins include gastrointestinal problems such as stomach cramps, diarrhea, nausea, and vomiting. 

Cephalosporin antibiotics are especially useful for treating infections in patients who are allergic to penicillins. Hypersensitivity to cephalosporins is much less common, and only about 5-10% of penicillin-sensitive patients will also be allergic to cephalosporins. 

As with the penicillins, hypersensitivity reactions are the most common systemic adverse events caused by cephalosporins. Maculopapular rash, urticaria, fever, bron-chospasm,and anaphylaxis have been associated with the use of cephalosporins.Because the molecular structure of the penicillins and the first-generation cephalosporins are similar, there is a risk in patients who are aUergic to penicillin to manifest aUergic cross-reactions when prescribed any of this gronp of cephalosporins. In contrast, the risk of cross-reactivity between the penicUUns and the second-, third-, and fonrth-generation cephalosporins has been overestimated, and patients with a previons aUergic... 

McDonnell TJ, FitzGerald MX. Cystic fibrosis and penicillin hypersensitivity. Lancet 1984 l(8389) 1301-2. 

Green GR, Rosenblum AH, Sweet LC. Evaluation of penicillin hypersensitivity value of clinical history and skin testing with penicilloyl-polylysine and penicillin G. A cooperative prospective study of the penicillin study group of the American Academy of Allergy. J Allergy Clin Immunol 1977 60(6) 339-45. 

Levine, B. B. Immunochemical mechanisms involved in penicillin hypersensitivity in experimental animals and in human beings. Fed. Proc. 24, 45 (1965). 

Cephalosporins. — Many patients with a history of penicillin hypersensitivity have shown no allergic response to cephalothin (x) 37,38, 39 cephaloridine (XI). 0 41... 

Aqueous crystalline penicillin G sodium With gentamicin sulfate 1 8 million units/24 h IV either continuously or in six equally divided doses 1 mg/kg IM or IV every 8 h 4 2 Cefazolin or other first-generation cephalosporins may be substituted for penicillin in patients whose penicillin hypersensitivity is not of the immediate type... 

Macrolides bind to the 50s subunit of ribosomes. They are effective against a wide range of bacteria and are active orally. Erythromycin in particular is an alternative in individuals with penicillin hypersensitivity. 

Vasculitis may be related to penicillin hypersensitivity. The Coombs reaction frequently becomes positive during prolonged therapy, but hemolytic anemia is rare. Reversible neutropenia has been noted, occurring in up to 30% of patients treated with 8-12 g nafcillin for longer than 21 days. Eosinophilia occasionally accompanies other allergic reactions to penicillin. 

A 24-year-old woman has primary syphilis. She has a history of penicillin hypersensitivity, so tetracycline will be used to treat the infection. Which one of the following statements about the proposed drug treatment of this patient is false ... 

Endocarditis Dental or oral procedures in high-risk patients Amoxicillin (PO) or ampicillin (IV) In penicillin hypersensitivity clindamycin (PO), or vancomycin (IV)... 

Dudley KH, Butler TC, Johnson D (1974) Chemical studies of potential relevance to penicillin hypersensitivity kinetic studies of methicillin, phenoxymethylpenicillin and their penicillenic acids. J Pharmacol Exp Ther 188 491-503 Duncan MR, Duncan GR (1973) Binding studies with calf thymus histones and H-cortisol. Can J Pharm Sci 8 115-119... 

Parker CW, de Week AL, Kern M, Eisen HN (1962) The preparation and some properties of penicillenic acid derivatives relevant to penicillin hypersensitivity. J Exp Med 115 803-819... 

Siegel BB (1962) Studies on penicillin hypersensitivity. V. Further studies on the antigenic properties of altered penicillin. J Allergy 33 349-355 Slingsby J, Zuck DA (1972) The kinetic behaviour of phenylbutazone in four solvent systems. Can J Pharm Sci 7 115-116... 

Thiel JA, Mitchell S, Parker CW (1964) The specificity of hemagglutination reactions in human and experimental penicillin hypersensitivity. J Allergy Clin Immunol 35 399 Thierfelder S, Eulitz M, Karl ML (1967) Immunologische Studien an einem Pyramidon-Leukozytenantikorper. Klin Wochenschr 45 78 Uehleke H (1962) Biochemische Reaktionen als Ursache erworbener Uberempfmdlichkeit gegen Fremdstoffe. Z Immunforsch 123 447... 

Veltman G (1959) Zur Kenntnis des Adalinexanthems. Z Haut Geschlkrh 27 11 Walsh JR, Zimmerman HJ (1953) The demonstration of the L.E. -phenomenon in patients with penicillin hypersensitivity. Blood 8 65 Watts JC (1962) A fatal case of erythema multiforme exsudativum (Stevens-Johnson syndrome) following therapy with Dilantin. Pediatrics 30 592 Webster AW, Thompson (1974) The ampicillin rash lymphocyte transformation by ampicillin polymer. Clin Exp Immunol 18 553 Weirich EG (1957) Das Pyrazolonexanthem. Dtsch Med Wochenschr 1011 Welsh AL (1961) The fixed eruption. Thomas, Springfield... 

However, this is still considered as open to question by some authors (Dewd-NEY 1977) who point out that the BPO determinant may appear predominant only because the testing methods mostly used for detection of penicillin hypersensitivity (skin and serological tests) appear to be most sensitive for this type of determinant. 

Since their introduction to therapy, the question of allergic cross-reactivity between cephalosporins and penicillins has been raised, and continues to be raised for each of the new cephalosporin molecules introduced (Petz 1971 Pevny et al. 1973). Immunopathological reactions to cephalosporins have been reported and often confirmed by objective tests. It is, however, frequently difficult to assess whether such reactions are due to cross-reactivity on the basis of preexisting penicillin hypersensitivity or whether it is the manifestation of a de novo sensitization to cephalosporin. 

Brown GL, Kanware BS (1967) Drug rashes in glandular fever. Lancet 2 1418 Budd MA, Parker CW, Norden CW (1964) Evaluation of intradermal skin tests in penicillin hypersensitivity. JAMA 190 203... 

Butcher BT, Stanfield MK, Stewart GT, Zemelman R (1971) Antibiotic polymers alpha-amino-benzylpenicillin (ampicillin). Mol Cryst Liq Cryst 12 321 Butler TC, Dudley KH, Johnson D (1972) Chemical studies of potential relevance to penicillin hypersensitivity kinetics of formation and disappearance of benzylpenicillenic acid and its derivatives in solutions of benzylpenicillin. J Pharmacol Exp Ther 181 201 Butterly JM, Fishman L (1972) Jarisch-Herxheimer reaction following penicillin therapy in case of symphilitic aortitis. JAMA 148 370... 

Coleman M, Siegel BB (1955) Studies in penicillin hypersensitivity. II. The significance of penicillin as a contaminant. J Allergy 26 253... 

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