Can someone help me make sense of this please?

[Quinn1988]

I had a friend get bitten on the back of the neck by a dog a couple weeks ago. After determining the bite was full-thickness, he was sent to the clinic to get the wound cleaned and banaged up. It was suggested by the PA he saw that he take Augmentin just to make sure things do not get worse, and promote healing with very minimal infection possibility. Problem with that is he is allergic to PCN, E-Mycyn, and Bactrim.The PCN allergy causes anaphylaxis which is well documented in medical records and has been since childhood. Also, he wears a medical braclet engraved with the words "PENICILLIN ALLERGY" Right on the back. After he asked the PA about the risks of taking Augmentin with a PCN allergy, the response was "I have seen it work fine in other pts with a PCN allergy"

Thoughts?

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[TSasser]

Found this on Drugs.com (This is not meant as any type of medical advise as this is again SDN policy and I am not a physician)

information about Augmentin: http://www.drugs.com/augmentin.html

Do not use Augmentin if you are allergic to amoxicillin or clavulanate potassium, or if you have ever had liver problems caused by this medication. Do not use if you are allergic to any other penicillin antibiotic, such as amoxicillin (Amoxil, Augmentin, Dispermox, Moxatag), ampicillin (Principen, Unasyn), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), or penicillin (Bicillin L-A, PC Pen VK, Pfizerpen), and others.

 

[senseiturtle]

1) We don't necessarily treat all animal bites with antibiotics. Dogs generally no. Irrigate, don't close it up, open up abscesses, and keep it clean. Human bites always get antibiotics. Cats are deep puncture wounds, so give something that covers pasturella.

Other animals are case-by-case.

2) Ampicillin is a "penicillin." Don't give it to someone with allergies to the penicillin group.

3) Doxycycline vs. clindamycin plus Fluoroquinolone ----

4) It should be determined whether or not these are true allergies, versus just sensitive to side-effects. Tons of people come in claiming they're allergic to something just because it gave them diarrhea or a headache. If you don't have hives or anaphylaxis, it's not an allergy.

 

[Quinn1988]

1) We don't necessarily treat all animal bites with antibiotics. Dogs generally no. Irrigate, don't close it up, open up abscesses, and keep it clean. Human bites always get antibiotics. Cats are deep puncture wounds, so give something that covers pasturella.

Other animals are case-by-case.

2) Ampicillin is a "penicillin." Don't give it to someone with allergies to the penicillin group.

3) Doxycycline vs. clindamycin plus Fluoroquinolone ----

4) It should be determined whether or not these are true allergies, versus just sensitive to side-effects. Tons of people come in claiming they're allergic to something just because it gave them diarrhea or a headache. If you don't have hives or anaphylaxis, it's not an allergy.

True. That is the thing though. Taking PCN results in anaphylaxis in this individual. Are headaches and diarrhea indicators of an allergic reaction? If so, I can honestly say I have never seen that one. Typically when I think of allergy first thing that comes to mind are hives and/or anaphylaxis. So unless I am missing something completely, the rationale "I have seen it work in other patients" makes no sense. By that logic, we all may as well be clones massive in numbers. My thing is why did it have to take a pharmacist and the medical director to see that one would have opened a pandora's box?

 

[deleted87716]

he asked the PA about the risks of taking Augmentin with a PCN allergy, the response was "I have seen it work fine in other pts with a PCN allergy"

Thoughts?

Obviously, giving Augmentin to somebody who has anaphylaxis to PCN is contraindicated. Are you seriously just looking for confirmation of that here, or are you implying something else?

 

[Quinn1988]

Obviously, giving Augmentin to somebody who has anaphylaxis to PCN is contraindicated. Are you seriously just looking for confirmation of that here, or are you implying something else?

It is contraindicated. However, that was not what I was getting at. What I was getting at is how could one come to the conclusion giving Augmentin to a patient who goes into anaphylactic shock after taking PCN would have remotely anything good coming from that situation? I have seriously tried to dissect this situation and I got nothing.

 

[deleted87716]

It is contraindicated. However, that was not what I was getting at. What I was getting at is how could one come to the conclusion giving Augmentin to a patient who goes into anaphylactic shock after taking PCN would have remotely anything good coming from that situation? I have seriously tried to dissect this situation and I got nothing.

Not really much there to dissect. You encountered a PA with a knowledge deficit. I suggest you report the incident to his employer.

 

[Quinn1988]

Not really much there to dissect. You encountered a PA with a knowledge deficit. I suggest you report the incident to his employer.

Which in turn accomplishes what exactly? I mean it has already been reported and everything, however, as seeing as the PA is still practicing and this is by far not the first "Knowledge deficit" I am rather unclear as to what this does in the long run.

 

[deleted87716]

Which in turn accomplishes what exactly? I mean it has already been reported and everything, however, as seeing as the PA is still practicing and this is by far not the first "Knowledge deficit" I am rather unclear as to what this does in the long run.

Whether his employer elects to fire or remediate him is up to them. It's their collective asses on the line, after all, if he screws up and they get sued.

Your friend could also report the PA to his state licensing board.

The only way you would know what transpired afterwards is if board actions are made public. In my state, they're posted on the board's web site. It sometimes takes a while for a complaint to be investigated and adjudicated. Typically, something like that could result in a sanction and perhaps some mandatory pharmacology CME. If the investigation revealed other issues, more serious penalties could result.

I should add that there are no grounds for a malpractice suit, as no injury occurred.

 

[Quinn1988]

Whether his employer elects to fire or remediate him is up to them. It's their collective asses on the line, after all, if he screws up and they get sued.

How often have you seen remediation work effectively?

Your friend could also report the PA to his state licensing board.

The only way you would know what transpired afterwards is if board actions are made public. In my state, they're posted on the board's web site. It sometimes takes a while for a complaint to be investigated and adjudicated. Typically, something like that could result in a sanction and perhaps some mandatory pharmacology CME. If the investigation revealed other issues, more serious penalties could result.

For clarification, if the individual who intiated the complaint went to a board that does not post the actions on public channels, would this individual still be able to inqure about end result/actions taken?

I should add that there are no grounds for a malpractice suit, as no injury occurred.

Very true and in this case, I am glad no injuries occured as seeing as there could really have been one injury that would have occured out of this....