Serum Sickness-Like Reactions to Amoxicillin, Cefaclor, Cephalexin, and Trimethoprim-Sulfamethoxazole

Platt, Richard; Dreis, Michael W.; Kennedy, Dianne L.; Kuritsky, Joel N.

doi:10.1093/infdis/158.2.474

Cited by 71 publications

(22 citation statements)

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“…Nonimmediate reactions occur after more than 1 hour and are manifested mainly by maculopapular rash, urticaria and serum sickness. [15] Serum sickness-like reactions (SSLR) are generally associated with penicillins, [17][18][19] cephalosporins, [18][19][20][21][22][23][24][25][26][27] cotrimoxazole (trimethoprim/sulfamethoxazole) [18] and tetracyclines. [28] Serum sickness proper, such as that induced by foreign proteins, is characterised by morbilliform and urticarial rash, fever and malaise.…”

Section: Diagnosis Of Antibacterial Hypersensitivitymentioning

confidence: 99%

“…erythema multiforme), arthropathy and fever. [17,18] Unlike the classic form, lymphadenopathy and renal involvement have rarely been reported during β-lactam therapy, [19] nor have circulating immune complexes been found in such patients. [27] Other pathogenic mechanisms have been hypothesised in connection with cefaclor (section 2.1.2).…”

Section: Diagnosis Of Antibacterial Hypersensitivitymentioning

confidence: 99%

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Recognising Antibacterial Hypersensitivity In Children

Romano

2000

Pediatric Drugs

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Adverse reactions to antibacterial agents are not uncommon in children. They are classified as 'immediate' or 'nonimmediate' according to the time interval between drug administration and onset. Immediate reactions occur within 1 hour and are manifested by urticaria and/or angioedema, bronchospasm and anaphylactic shock; immunological reactions are mediated by IgE antibodies. The main nonimmediate reactions (occuring after more than 1 hour) are maculopapular rash, urticaria and serum sickness; T lymphocytes may participate in maculopapular rash. Clinical assessment of such reactions is complex. The patient's history is fundamental; the allergological examination includes in vivo and in vitro tests selected on the basis of the clinical features and the phase of reaction. In the late phase, prick and intradermal tests are sensitive in evaluating beta-lactam allergy. Together with delayed-reading intradermal testing, patch testing seems to be useful in diagnosing maculopapular reactions to systemically administered aminopenicillins. Determination of specific IgE levels is the most common in vitro method for diagnosing immediate reactions. In the acute phase, serum tryptase and urinary N-methylhistamine assays are reliable in diagnosing type I pathogenic mechanisms in immediate reactions. Unfortunately, there are few in vitro tests for evaluating other reactions, and most are not fully validated. In selected cases, provocation tests should be performed.

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Section: Diagnosis Of Antibacterial Hypersensitivitymentioning

confidence: 99%

Section: Diagnosis Of Antibacterial Hypersensitivitymentioning

confidence: 99%

Recognising Antibacterial Hypersensitivity In Children

Romano

2000

Pediatric Drugs

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“…abwartendes Prozedere, NSAIDs und Kortikoide. Nicht nur Impfungen sind Auslöser für oben genannte Reaktionen, sondern auch Medikamente und insbesondere Antibiotika wie Amoxicillin, Cefaclor, Cephalexin und Trimethoprim-Sulfamethoxazol [ 152 ] .…”

Section: Hypersensitivitätunclassified

Erkrankungen der Halslymphknoten im Kindesalter

Lang

Kansy

2014

Laryngo-Rhino-Otol

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The lymph nodes are an essential part of the body's immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) - a critical aspect especially among children - and can represent an early clinical sign in their exposed position on a child's slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance - from banal infections to malignant diseases - demand a clear and considered approach to the child's individual clinical presentation. Such an approach is described in the following paper.

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“…The author advocates avoiding the use of cefaclor in children because of the 1.5 to 3.4% incidence of serum sickness-like reactions that have been reported. [58,59] The 2 combination sulpha drugs used for AOM (cotrimoxazole and erythromycin-sulfisoxazole) may cause generalised maculopapular and urticarial rashes in a small but significant number of children. Any antibiotic, but in particular cotrimoxazole, can rarely cause a severe and life-threatening Stevens-Johnson syndrome.…”

Section: 6 Adverse Effectsmentioning

confidence: 99%

Management of Acute Otitis Media in the 1990s

Block

1999

Pediatric Drugs

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Acute otitis media (AOM) has become increasingly difficult to treat in the 1990s, the decade of drug-resistant pneumococcus. Throughout the world, drug-resistant strains of this pathogen are being recovered from 20 to 50% of cases of initial untreated AOM, and from 45 to 90% of refractory AOM. Almost as alarming is that beta-lactamase-producing strains of Haemophilus influenzae are currently being isolated in 40 to 50% of cases of AOM in the US. Clinicians can no longer expect 'Pollyanna-like' high rates of clinical resolution for this disease. It is now imperative that they become aware of the regional prevalence of these drug-resistant bacteria and, just as importantly, their patterns of antibacterial resistance. Although some authors would hold that any antibacterial, or even placebo, should be adequate for most cases of AOM, clinical practice appears to suggest otherwise. Amoxicillin, still the first-line therapeutic choice for initial nonrefractory AOM, will often fail. The real dilemma begins when clinicians search for clinical data to select an antibacterial for therapeutic failures--few data are available. Thus, to give optimal treatment to a child who has failed antibacterial therapy--the true actual indication for all second-line antibacterials--they must instead become familiar with the following in vivo and in vitro data: 1. 'In vivo sensitivity data': otherwise known as bacteriological efficacy, in which repeat tympanocentesis is performed in mid-therapy. This reveals the bacterial 'Achilles heel' or weakness for the individual antibacterial agents. 2. Clinical efficacy data: analysis of rates of clinical resolution after therapy in comparative trials which use a single tympanocentesis initially and a 'gold standard' comparator antibacterial. 3. 'Bug to drug' data: comparison of reported middle ear concentrations for each individual antibacterial agent relative to the respective minimum inhibitory concentrations of isolates, particularly drug-resistant pneumococcus and H. influenzae (if possible, obtained from the paediatric respiratory tract). The selection of an antibacterial agent for AOM in any particular case should not be merely a random process. It involves awareness of the pathogens most likely to be observed: with co-infections; after failure with a particular antibacterial (the bacterial 'Achilles heel' of the drug); and at different points in time, whether initially or after therapeutic failures (e.g. first-line versus fourth-line failure).

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Serum Sickness-Like Reactions to Amoxicillin, Cefaclor, Cephalexin, and Trimethoprim-Sulfamethoxazole

Cited by 71 publications

References 0 publications

Recognising Antibacterial Hypersensitivity In Children

Recognising Antibacterial Hypersensitivity In Children

Erkrankungen der Halslymphknoten im Kindesalter

Management of Acute Otitis Media in the 1990s

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