Determining safe antibiotics for drug hypersensitive patients with the alternative method of double-triple test

Allergic reactions to antibiotics are common in daily clinical allergy practice. Oral drug provocation tests (ODPT) are used to determine safe alternative antibiotics in addition to diagnostic purposes. In one of our previous studies, we have shown that triple test was a safe, time-saving and cost-effective method for determining safe alternatives for patients with non-steroidal anti-inflammatory drug (NSAID) hypersensitivity.

Our aim was to investigate the safety of one day two or three antibiotic ODPT performed to find safe alternative antibiotics in antibiotic/NSAID hypersensitive patients, as a cost effective and time saving alternative to conventional one day one antibiotic ODPT.

Fifty-three patients were enrolled into this survey between 1 September 2005 and 31 December 2006. Double and triple tests are defined as performing ODPT with two and three antibiotics consecutively on the same day.

Mean age of the patients was 41.3 +/- 11.7 years and 71.7 % were females. Beta-lactams (41.5 %) were the antibiotics most commonly causing reactions and the most common reaction was urticaria (68.8 %). Double test was performed in 26 (ciprofloxacin + clarithromycin, ciprofloxacin + tetracyline, clarithromycin + tetracycline, ciprofloxacin + ampicillin and ciprofloxacin + roxithromycin) and triple test in 27 patients (ciprofloxacin + tetracycline + clarithromycin, ciprofloxacin + tetracycline + ampicillin, clarithromycin + tetracycline + clindamycin and clarithromycin + ciprofloxacin + ampicillin). Only four patients had positive reactions during triple and double tests. There were no serious adverse reactions. Sixty-five days have been spent with triple-double tests where it would be 136 days with the conventional method.

The triple-double ODPT performed with antibiotics in antibiotic/NSAID hypersensitive patients with the purpose of determining a safe alternative antibiotic could be a safe, cost-effective and time-saving alternative to conventional one day one antibiotic ODPT.