Important Note

Abstract

Penicillin allergy Penicillins are part of the beta-lactam family and include: • Penicillin (penicillin V, benzyl penicillin) • Amoxicillin and ampicillin • Co-amoxiclav (Augmentin, i.e. amoxicillin and clavulanic acid) • Flucloxacillin • Pivmecillinam (mecillinam) • Cefalexin Nausea, vomiting or diarrhoea are common side effects of any antibiotic, and do not, by themselves, constitute an allergic reaction. They are NOT a contraindication for penicillin use. Genuine penicillin allergy takes the form of an urticarial rash or anaphylaxis/ angioedema. Rash reaction to penicillin There is around 15% probability that patients with penicillin allergy will be allergic to cephalosporins such as Cefalexin. Anaphylaxis/Angioedema to penicillin An anaphylactic reaction related to histamine release occurs 30-60 minutes after administration of penicillin. Symptoms may include erythema or pruritis, angioedema, hypotension or shock, urticaria, wheezing or rhinitis. An accelerated allergic reaction occurs 1-72 hours after previous administration of penicillin: symptoms may include erythema or pruritis, angioedema, urticaria, wheezing or rhinitis (particular caution if symptoms include laryngeal oedema). Patients with anaphylaxis to penicillin should never be given any beta-lactam antibiotic (cephalosporins or carbapenems). Unknown/uncorroborated history of penicillin allergy For patients who are unable to give a clear history of penicillin allergy reaction, please try, where possible, to gain colla teral history from relatives including antibiotic use history. Fluoroquinolone Antibiotics Warning Fluoroquinolones (Ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin) can cause very rare but disabling and potentially long-lasting or irreversible side effects. Scale of the risk-A review of EudraVigilance database identified 286 cases of serious adverse reactions reported as disabling and lasting for 30 days or more, without any alternative explanations, from across the EU over a 21-year period. It is estimated that more than 300 million daily doses of fluoroquinolone antibiotics are dispensed every year in the EU. The details of the warning against fluoroquinolones can be found here: https://www.gov.uk/drug-safety-update/ fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects#new-restricted-indications Fluoroquinolones in these guidelines are used where better alternatives, in essentially patients allergic to penicillins, can not be found. You may wish to discuss these risks with the patient. Penicillin allergy Penicillins are part of the beta-lactam family and include: • Penicillin (penicillin V, benzyl penicillin) • Amoxicillin and ampicillin • Co-amoxiclav (Augmentin, i.e. amoxicillin and clavulanic acid) • Flucloxacillin • Pivmecillinam (mecillinam) • Cefalexin Nausea, vomiting or diarrhoea are common side effects of any antibiotic, and do not, by themselves, constitute an allergic reaction. They are NOT a contraindication for penicillin use. Genuine penicillin allergy takes the form of an urticarial rash or anaphylaxis/ angioedema. Rash reaction to penicillin There is around 15% probability that patients with penicillin allergy will be allergic to cephalosporins such as Cefalexin. Anaphylaxis/Angioedema to penicillin An anaphylactic reaction related to histamine release occurs 30-60 minutes after administration of penicillin. Symptoms may include erythema or pruritis, angioedema, hypotension or shock, urticaria, wheezing or rhinitis. An accelerated allergic reaction occurs 1-72 hours after previous administration of penicillin: symptoms may include erythema or pruritis, angioedema, urticaria, wheezing or rhinitis (particular caution if symptoms include laryngeal oedema). Patients with anaphylaxis to penicillin should never be given any beta-lactam antibiotic (cephalosporins or carbapenems). Unknown/uncorroborated history of penicillin allergy For patients who are unable to give a clear history of penicillin allergy reaction, please try, where possible, to gain colla teral history from relatives including antibiotic use history. Fluoroquinolone Antibiotics Warning Fluoroquinolones (Ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin) can cause very rare but disabling and potentially long-lasting or irreversible side effects. Scale of the risk-A review of EudraVigilance database identified 286 cases of serious adverse reactions reported as disabling and lasting for 30 days or more, without any alternative explanations, from across the EU over a 21-year period. It is estimated that more than 300 million daily doses of fluoroquinolone antibiotics are dispensed every year in the EU. The details of the warning against fluoroquinolones can be found here: https://www.gov.uk/drug-safety-update/ fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects#new-restricted-indications Fluoroquinolones in these guidelines are used where better alternatives, in essentially patients allergic to penicillins, can not be found. You may wish to discuss these risks with the patient.