Antibiotics interactions

[Tessy]

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Hi, I am struggling with antibiotics administration and allergies. You know, you have a patient with 3-4 different allergies to antibiotics. You need to treat them for uti, pneumonia, etc. Is there a table/ web-site/ book/ app that clearly explains all he interactions? What antibiotics may be used?
Thanks.

 

[gutonc]

Hi, I am struggling with antibiotics administration and allergies. You know, you have a patient with 3-4 different allergies to antibiotics. You need to treat them for uti, pneumonia, etc. Is there a table/ web-site/ book/ app that clearly explains all he interactions? What antibiotics may be used?
Thanks.

Micromedex if you have access. Epocrates if you don't.

 

[Rendar5]

Hi, I am struggling with antibiotics administration and allergies. You know, you have a patient with 3-4 different allergies to antibiotics. You need to treat them for uti, pneumonia, etc. Is there a table/ web-site/ book/ app that clearly explains all he interactions? What antibiotics may be used?
Thanks.

Don't worry about allertic cross-reactivity between various families of antibiotics, honestly. It's overblown and may be more myth than fact. People who are allergic to one antibiotic have a tendency to develop allergies to others. just know what family an antibx is in and pick another family.

 

[gutonc]

Don't worry about allertic cross-reactivity between various families of antibiotics, honestly. It's overblown and may be more myth than fact. People who are allergic to one antibiotic have a tendency to develop allergies to others. just know what family an antibx is in and pick another family.

I agree with this as well. The vast majority of antibiotic "allergies" boil down to a 67yo saying "well, my mom told me I had a rash when I took amoxicillin as a baby" or "I get diarrhea when I take clindamycin." When confronted with an antibiotic allergy, always ask about it. Most of them are either complete fabrications or just unpleasant side effects.

I was focusing more on drug interactions with my recommendations.

 

[Top Gun]

If a patient claims to be allergic to antibiotics, ask them what kind of reaction s/he has. Like gutonc says, it may be just a side effect to that particular antibiotic. Anyways, Epocrates is a pretty good resource for selecting any antibiotics you wish to use and finding possible alternative ones, and also for checking drug interactions.

 

[Rendar5]

that all reminds me, I had a patient w/ multiple drug allergies just a few weeks ago w/ a pna that was appropriate to outpt, but no possible meds if you just looked at the list.. actually getting into it, the doxycycline allergy was the classic sun reaction. Put her on it, told her to stay out of the sun.

 

[Tessy]

I know that we need to ask about specific reactions, however sometimes patients come from nursing home, they are baseline confused , and we are stuck with allergies written on their record. I guess my main question was about cross-reactivity rather than interaction with other meds. That information is easily obtainable on epocrates. But how about cross-reactivity? I will get in trouble at our hospital if I start somebody on antibiotic that has a cross-reactivity with antibiotic patient is allergic to.

 

[Rendar5]

I know that we need to ask about specific reactions, however sometimes patients come from nursing home, they are baseline confused , and we are stuck with allergies written on their record. I guess my main question was about cross-reactivity rather than interaction with other meds. That information is easily obtainable on epocrates. But how about cross-reactivity? I will get in trouble at our hospital if I start somebody on antibiotic that has a cross-reactivity with antibiotic patient is allergic to.

Ignore cross-reactivity, it's mostly BS for separate families. Just don't use antibiotics in the same family as those they're allergic to. And if you're intent on learning the important cross-reactivities, there's only one and it's almost questionable. It's 1st (read again, 1st) generation cephalosporins with penicillins. 2nd and 3rd do not have any significant cross-reactivity.

 

[DrSnips]

Ignore cross-reactivity, it's mostly BS for separate families. Just don't use antibiotics in the same family as those they're allergic to. And if you're intent on learning the important cross-reactivities, there's only one and it's almost questionable. It's 1st (read again, 1st) generation cephalosporins with penicillins. 2nd and 3rd do not have any significant cross-reactivity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070890/

This backs what you're saying but goes even further to mention that the data on cross-reactivity with 1st gen cephalosporins came at a time when the manufacturing process contaminated those drugs with penicillin. This suggests there might not be any significantly increased risk of cross-rxn for any cephalosporin, 1st gen included.

 

[Top Gun]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070890/

This backs what you're saying but goes even further to mention that the data on cross-reactivity with 1st gen cephalosporins came at a time when the manufacturing process contaminated those drugs with penicillin. This suggests there might not be any significantly increased risk of cross-rxn for any cephalosporin, 1st gen included.

Hell, I've given Keflex a few times to patients with penicillin allergies, and they did fine.