LIFE THREATENING ANAPHYLAXIS WITH CO-AMOXICLAV DESPITE HAVING A PREVIOUS TOLERANT EXPOSURE TO THE ANTIBIOTIC
Abstract
Background: Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a case of 61 years old lady came to outpatient clinic with a diagnosis of right sided lower alveolar tumour. A plan was made to proceed with a Right Marginal Mandibulectomy. She received Co amoxiclav as prophylactic antibiotic and was clinically uneventful. On further questioning there were many different occasions on which the patient had oral co amoxiclav with no complications or side effects. No known drug allergies or otherwise were documented. As a part of surgical antibiotic prophylaxis, Co amoxiclav 1.2 gm was given to patient at the time of induction. After the antibiotic administration patient started having bronchospasm with increased airway pressures and severe hypotension indicating anaphylactic reaction. The patient was resuscitated, recovered from the anaphylactic shock successfully and provided extended recovery in post anaesthesia care unit followed by High Dependency Unit for overnight monitoring. Every centre or ward that administers injectable antibiotics have to have a standard protocol for the management of allergy reactions. A timely fashion is mandatory to make the best use of the drugs available and emergency gadget ought to be in vicinity in case this type of state of affairs rise up.Keywords: co amoxiclav; anaphylaxis; alveolar tumour; mandibulectomyReferences
Antu´nez C, Martý´n E, Cornejo-Garcý´a JA, Blanca-Lopez N, R-Pena R, Mayorga C, et al. Immediate hypersensitivity reactions to penicillins and other betalactams. Curr Pharm Des 2006;12:3327–33.
Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, et al. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy 2015;45(2):300–27.
Idsoe O, Guthe T, Willcox RR, De Weck AL. Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock. Bull World Health Organ 1968;38(2):159–88.
Torres MJ, Blanca M, Fernandez J, Romano A, De Weck A, Aberer W, et al. Diagnosis of immediate allergic reactions to beta-lactam antibiotics. Allergy 2003;58(10):961–72.
Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States, 1999-2010: patterns and demographic associations. J Allergy Clin Immunol 2014;134(6):1318–28.
Sue MA, Noritake DT, Klaustermeyer WB. Penicillin anaphylaxis: fatality in elderly patients without a history of penicillin allergy. Am J Emerg Med 1988;6(5):456–8.
Simons FER, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J 2015;8(1):32.
Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000;30(8):1144–50.
Simons KJ, Simons FE. Epinephrine and its use in anaphylaxis: current issues. Curr Opin Allergy Clin Immunol 2010;10(4):354–61.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
