Practical Management of Antibiotic Hypersensitivity in 2017

Area of Science:

• Clinical Immunology
• Pharmacology
• Infectious Diseases

Background:

• Antibiotics are frequently reported as causing allergy or intolerance, with varying incidence rates dependent on the specific drug.
• Adverse reactions to antibiotics are more prevalent in females, older individuals, hospitalized patients, and those with higher antibiotic consumption.
• Many reported antibiotic hypersensitivity reactions are not reproducible or immunologically mediated.

Purpose of the Study:

• To explore the mechanisms behind antibiotic hypersensitivity reactions.
• To outline current diagnostic and management strategies for antibiotic allergy.
• To emphasize the role of managing antibiotic hypersensitivity within antibiotic stewardship programs.

Main Methods:

• Review of diagnostic tools for antibiotic hypersensitivity, including skin testing and direct challenges.
• Evaluation of the clinical utility of in vitro testing for antibiotic hypersensitivity.
• Discussion of desensitization protocols for confirmed immunologically mediated hypersensitivity.

Main Results:

• Skin testing and direct challenges are primary methods for assessing acute tolerance to antibiotics.
• Current in vitro testing lacks broad clinical utility for diagnosing antibiotic hypersensitivity.
• Desensitization is effective for acute-onset immunologically mediated hypersensitivity but not for T-cell-mediated delayed reactions.

Conclusions:

• Accurate diagnosis of antibiotic hypersensitivity is crucial for effective management.
• Skin testing and desensitization are valuable tools when indicated.
• Managing antibiotic allergy is integral to successful antibiotic stewardship.