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Antibiotic therapy in the allergic patient
J Segreti1, G M Trenholme, S Levin
1Section of Infectious Disease, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, Illinois, USA.
Abstract:
A variety of antimicrobial classes are now available. Thus, a careful history and skin testing for hypersensitivity reactions are often not done. It is often easier to give an alternative agent rather than to determine if the person does indeed have a hypersensitivity reaction to a particular drug. There remain situations (e.g., enterococcal endocarditis, neurosyphilis, syphilis in pregnant women), however, in which options for appropriate therapy are limited. In this setting, an accurate history accompanied by appropriate skin testing and desensitization is indicated.
Insights
Despite many antimicrobial options, hypersensitivity reactions are often not evaluated. However, for limited-therapy situations like neurosyphilis, accurate history, skin testing, and desensitization are crucial.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- A wide array of antimicrobial agents are available for clinical use.
- Routine assessment for hypersensitivity reactions to antimicrobials is often bypassed due to the availability of alternative treatments.
- This practice can lead to challenges when treatment options are limited.
Purpose of the Study:
- To highlight the importance of accurate history taking and diagnostic testing for antimicrobial hypersensitivity.
- To emphasize the necessity of skin testing and desensitization in specific clinical scenarios.
- To address situations where therapeutic choices are restricted.
Main Methods:
- Review of clinical guidelines and literature on antimicrobial hypersensitivity.
- Analysis of specific conditions with limited antimicrobial options.
- Discussion of diagnostic approaches including patient history and skin testing.
Main Results:
- Hypersensitivity reactions are frequently presumed rather than definitively diagnosed.
- Alternative agent prescription is common, avoiding detailed hypersensitivity workups.
- Certain infections, such as enterococcal endocarditis, neurosyphilis, and syphilis in pregnant women, present therapeutic limitations.
Conclusions:
- Accurate hypersensitivity assessment is vital, especially when treatment options are scarce.
- Skin testing and desensitization protocols are indicated in specific, high-risk clinical situations.
- A thorough diagnostic approach ensures appropriate and effective antimicrobial therapy.