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Desensitization to ceftaroline in a patient with multiple medication hypersensitivity reactions
Justin M Jones1, Lisa M Richter1, Augusto Alonto1
1Justin M. Jones, Pharm.D., is Postgraduate Year 1 Pharmacy Resident; Lisa M. Richter, Pharm.D., BCPS, is Postgraduate Year 1 Pharmacy Residency Director; Augusto Alonto, M.D., is Infectious Disease Physician, Division of Infectious Diseases; and David D. Leedahl, Pharm.D., BCPS, is Clinical Pharmacy Manager, Sanford Medical Center, Fargo, ND.
Summary
This case study details successful ceftaroline desensitization in a patient with multiple drug hypersensitivities and a methicillin-resistant Staphylococcus aureus (MRSA) infection. The protocol enabled safe administration of ceftaroline, crucial for treating severe MRSA infections.
Area of Science:
- Clinical Medicine
- Infectious Diseases
- Pharmacology
Background:
- A patient presented with methicillin-resistant Staphylococcus aureus (MRSA) infection, complicated by extensive hypersensitivity reactions to multiple antibiotics, including penicillin and daptomycin.
- The patient had a history of severe reactions such as anaphylaxis and urticaria to various antibiotics, necessitating alternative treatment strategies.
Observation:
- A ceftaroline desensitization protocol was developed and implemented, involving serial infusions with escalating doses over 225 minutes.
- The protocol utilized intramuscular epinephrine, intravenous diphenhydramine, and intravenous methylprednisolone as needed to manage potential immediate hypersensitivity reactions.
Findings:
- The patient tolerated the full cumulative dose of ceftaroline (574.94 mg) without any breakthrough hypersensitivity symptoms during or after the desensitization process.
- Following successful desensitization, the patient received a six-week course of ceftaroline fosamil (600 mg IV every 12 hours) without apparent adverse effects.
Implications:
- Ceftaroline desensitization is a viable strategy for managing severe MRSA infections in patients with a history of multiple antibiotic allergies.
- This approach expands treatment options for patients with complex hypersensitivity profiles, potentially improving outcomes in challenging infectious disease cases.
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