Tetracycline allergy

Skin tests with various tetracycline compounds in different concentrations have been performed by many clinicians. Unfortunately, non-sensitizing conjugates of tetracyclines with small polypeptide carriers are not available. This is mainly due to our inadequate knowledge of the haptenic determinants responsible for tetracycline allergies. Therefore no effective diagnostic skin tests exist at present. 

There are no reports in the literature regarding radioallergosorbent tests (RAST) in IgE-mediated tetracycline allergies. Precipitating antibodies have been... 

Alternatives In non-pregnant patients with a penicillin allergy, alternative regimens include doxycycline 100 mg orally two times daily for 4 weeks or tetracycline 500 mg orally four times daily for 4 weeks. 

Bismuth Subsalicylate (Pepto-Bismol) [Antidiarrheal/ Adsorbent] [OTC] Uses Indigestion, N, D combo for Rx of H. pylori Infxn Action Antisecretory anti-inflammatory E>o e Adults. 2 tabs or 30 mL PO PRN (max 8 doses/24 h) Feds. 3—6 y 1/3 tab or 5 mL PO PRN (max 8 doses/24 h) 5-9 y 2/3 tab or 10 mL PO PRN (max 8 doses/24 h) 9-72 y 1 tab or 15 mL PO PRN (max 8 doses/24 h) Caution [C, D (3rd tri), -] Avoid w/ renal failure Hx severe GI bleed Contra Influenza or chickenpox (T risk of Reye synd), ASA allergy (see Aspirin) Disp Chew tabs, caplets, Liq, susp SE May turn tongue stools black Interactions T Effects OF ASA, MTX, valproic acid effects OF tetracyclines i effects W/ corticosteroids, probenecid EMS Monitor for hypovolemia and electrolyte disturbances d/t D may darken tongue stool OD Similar to ASA OD V, tinnitus, metabolic acidosis activated charcoal may be effective... 

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... 

Minocycline (Solodyn) [Anribiotic/Tetracycline] Uses Acne Action Tetracycline, bacteriostatic Dose Adults Peds >12y. 1 mg/kg PO daily x l2wk w/ food to X- irritation Caution [C, ] assoc w/ pseudomembranous colitis w/ renal impair Contra Allergy, women of childbearing potential Disp Tabs SE D, HA, fever, rash, joint pain, fatigue, dizziness Interactions T Effects OF digoxin, oral anticoagulants T risk of nephrotox W/ methoxyflurane X- effects W/... 

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... 

In order to reduce the risk of allergy, use of medicines has been tested. It seems an interesting idea to use tetracyclines deprived of antibiotic properties (mino and doxy-cyklines), administered orally to mice to reduce Ig E concentration. An inversely proportional relationship to the dose has been reported (Durkin et al., 2007). 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Since tetracyclines were introduced into pharmacotherapy, the phenomenon of photo-allergy/photo-sensitization is well known. Another group of highly effective and relatively modem anti-infectives are the quinolones (pefloxacin, ofloxacin, norfloxacin,... 

Adverse reactions. Erythromycin is remarkably nontoxic, but the estolate can cause cholestatic hepatitis with abdominal pain and fever which may be confused with viral hepatitis, acute cholecystitis or acute pancreatitis. This is probably an allergy, and recovery is usual but the estolate should not be given to a patient with liver disease. Other allergies are rare. Gastrointestinal disturbances occur frequently (up to 28%), particularly diarrhoea and nausea, but, with the antibacterial spectrum being narrower than with tetracycline, opportunistic infection is less troublesome. 

Menon MP, Das AK. Tetracycline asthma—a case report. Clin Allergy 1977 7(3) 285-90. 

Bojs G, Moller H. Eczematous contact allergy to oxytetra-cycline with cross-sensitivity to other tetracyclines. Berufsdermatosen 1974 22(5) 202-8. 

Assess patient allergies to determine if allergic to penicillin (or other antibiotics) so that drug regimens that contain penicillin (or other antibiotics) can be avoided. Avoid regimens that contain tetracycline in children. 

Agneu ( neu ) Moania complains to his physician of a fever and cough. His cough produces thick yellow-brown sputum. A stain of his sputum shows many Gram-positive, bullet-shaped diplococci. A sputum culture confirms that he has pneumonia, a respiratory infection caused by Streptococcus pneumoniae, which is sensitive to penicillin, erythromycin, tetracycline, and other antibiotics. Because of a history of penicillin allergy, he is started on oral erythromycin therapy. 

Sulfonamides have minimal therapeutic actions in rickettsial infections. Chloramphenicol may be used for Rocky Mountain spotted fever in patients with established allergy or other contraindication to tetracyclines. The answer is (C). 

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