Active Ingredient: Amoxicillin
A detailed history about the allergic reaction is important is discerning between a true allergy and a simple gastrointestinal GI intolerance.
Those patients could potentially receive a penicillin if necessary, despite the allergy label. Reliance on history alone can result in overdiagnosis of allergy. Approximately 0. There are several disadvantages and limitations to routine skin testing of all patients with a history of penicillin allergy.
First, the MDM must be compounded freshly, as a commercial preparation is not available 189, which can be time-consuming and costly. Recent data has suggested that the likelihood of sensitization by skin testing is small 175.
Third, skin testing does not identify patients at risk for Type II-IV reactions, though these are generally not immediately life-threatening effects in the way anaphylaxis is.
Skin testing would be an alternative in patients with a positive history of an allergy and with an infection that a penicillin would be a drug of choice.
In patients with a positive history of penicillin allergy with a negative skin test, penicillin use appears to be safe 145, but caution is recommended.
Desensitization In instances such as Enterococcal endocarditis, neurosyphilis, and in infections with organisms resistant to other antibiotics, desensitization should be considered in a patient with a likelihood of a Type I allergic reaction occurring desensitization is not effective in preventing Type II-IV reactions.
The procedure should be continuously supervised intensive care setting preferred and epinephrine should be available.
An advantage to the oral route is that it is shorter and can possibly be safer, though in one study 5 of 25 patients receiving oral penicillin desensitization acutely developed urticaria, pruritus, and angioedema 220.
Cross-Reactivity with Other Beta-Lactams and Related Compounds There is a concern over the potential for allergy to other beta-lactam compounds, such as cephalosporins, aztreonam, and the carbapenems, in patients allergic to penicillin.
No major or minor determinants exist with cephalosporins, which could account for the low cross-reaction potential. The potential for a cross-reaction with penicillamine has also been explored, as penicillamine is a metabolite of penicillin degradation.
A study examined 40 patients with a positive history of penicillin allergy. Family history of tendon is also not a risk factor.
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