Treating through in pediatric patients: a single-center experience

Mild cutaneous eruptions during drug therapy in hospitalized children often lead to treatment discontinuation. Data on continuation strategies such as treating through (TT) in pediatric patients are limited. To evaluate the safety and outcomes of the TT approach in hospitalized children with mild cutaneous drug eruptions. Patients aged 0-18 years hospitalized between September 2019 and June 2025 and evaluated for suspected drug allergy were included if they had mild cutaneous eruptions without systemic involvement and continued the suspected drug. Demographic, clinical, and treatment outcome data were analyzed. Ninety patients were included (median age 96 months; 60% male). Antibiotics were the most common suspected drugs (73.3%), with beta-lactams predominating (37.8%). Maculopapular rash occurred in 78.9% and urticaria in 21.1%. Reactions developed on the first day in 33.3% and within 6 h after the last dose in 74.4%. Treatment was successfully completed in 98.9% of patients; only one patient required discontinuation due to rash progression during fluconazole therapy.

In carefully selected hospitalized children with non-severe cutaneous drug eruptions, the TT approach appears to be a safe and effective strategy when continuation of therapy is clinically necessary.

Not applicable.

• Mild cutaneous drug eruptions, particularly maculopapular exanthems and delayed urticaria without systemic involvement, are generally considered low-risk phenotypes in children; however, they are frequently interpreted as drug allergy and may lead to unnecessary discontinuation of essential therapies. • "Treating through" (TT), defined as continuing the suspected drug despite a mild, non-severe cutaneous eruption when treatment is clinically necessary, has been described mainly in adults, while pediatric evidence remains limited.

• In this single-center cohort of 90 hospitalized children with mild cutaneous eruptions and no systemic involvement, treatment was successfully completed in 89 patients (98.9%) when the suspected drug was continued using a TT approach. • These findings suggest that, in carefully selected children requiring essential therapy, TT may be a feasible strategy to avoid unnecessary treatment discontinuation when implemented with individualized risk-benefi t assessment and close clinical monitoring.