open access

Vol 84, No 1 (2016)
ORIGINAL PAPERS
Submitted: 2016-01-19
Accepted: 2016-01-19

Typing safe antibiotics in amoxicillin hypersensitive patients — development of a stepwise protocol

Krzysztof Specjalski, Karolina Kita-Milczarska, Marta Chełmińska, Ewa Jassem
DOI: 10.5603/PiAP.2016.0001
·
Pneumonol Alergol Pol 2016;84(1):16-21.

open access

Vol 84, No 1 (2016)
ORIGINAL PAPERS
Submitted: 2016-01-19
Accepted: 2016-01-19

Abstract

Introduction: A history of an adverse reaction to amoxicillin, irrespective of the mechanism involved, significantly elevates patients’ anxiety and affects therapeutic decisions in the future, leading to unnecessary avoidance of antibiotics. As a consequence, it would be useful to find a safe and reliable protocol for typing safe alternative antibiotics. The aim of the study was to determine negative predictive value of typing safe antibiotic in patients with a history of hypersensitivity reaction to amoxicillin.

Material and methods: 71 patients, aged 20−83, with a history of an adverse reaction to amoxicillin were retrospectively analysed. On the basis of the reaction type they were divided into three groups: A — symptoms not typical for hypersensitivity reactions, B — allergy manifested by urticaria and/or angioedema, C — anaphylaxis. In group A amoxicillin was tested, in group B — cefuroxime, and in group C — macrolide: azithromycin or clarithromycin. Telephone follow-up visits were performed twice: 6−12 months and 3−5 years after the clinical assessment to evaluate tolerance of antibiotics. On the basis of the follow-up results, the negative predictive value (NPV) of the protocol was calculated.

Results: The full diagnostic protocol was applied in 62 participants. Amoxicillin was found safe in 22, cefuroxime — in 21 and macrolide — in 19 patients. No anaphylactic reactions were observed during the tests. On the basis of the telephone follow-up, the NPV of the protocol was 96% in the first follow-up and 97% in the second one.

Conclusion: A stepwise approach including SPTs, ICTs and provocations with amoxicillin / cefuroxime/macrolide — depending on a patient’s history — is safe and allows typing an antibiotic in the vast majority of patients.

Keywords

beta-lactam allergy, drug allergy management, drug challenge test, skin tests, drug typing

About this article
Title

Typing safe antibiotics in amoxicillin hypersensitive patients — development of a stepwise protocol

Journal

Advances in Respiratory Medicine

Issue

Vol 84, No 1 (2016)

Pages

16-21

DOI

10.5603/PiAP.2016.0001

Bibliographic record

Pneumonol Alergol Pol 2016;84(1):16-21.

Keywords

beta-lactam allergy
drug allergy management
drug challenge test
skin tests
drug typing

Authors

Krzysztof Specjalski
Karolina Kita-Milczarska
Marta Chełmińska
Ewa Jassem

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