A boy, aged 2 years, presented to a pediatric urgent-care clinic and was diagnosed with a serum sickness-like reaction in response to antibiotics prescribed for acute otitis media (AOM). The classic symptoms presented 6 hours after intramuscular injection of ceftriaxone [Rocephin]; however, prior to that injection, the patient had a full 10-day course of high-dose amoxicillin [Amoxil, Larotid, Moxtag] followed by four days of no medications and then 48 hours of high-dose amoxicillin and clavulanic acid (Amoclav, Augmentin, Clavamox).

Given this history, what would you prescribe for a future AOM or other infection that would typically call for a penicillin? Would you tell the family to treat this as a penicillin allergy? — Janis Mandac-DY, CPNP San Francisco

The term “serum sickness” refers to an allergic-like reaction to the administration of antibodies or to protein-containing therapies used to treat immune conditions. I suspect that Ms. Mandac-Dy is referring to a systemic allergic reaction that was not anaphylaxis. Symptoms of an allergic reaction to a drug can develop during the course of treatment or, in rare cases, up to a couple of weeks after the drug was administered. Augmentin lists serum sickness-like reaction as an adverse reaction, and Rocephin lists serum sickness as an adverse reaction. 

Given the small chance for cross-reactivity with cephalosporins, the penicillin family should both be avoided until testing can be done to determine a true penicillin allergy (Allergy Asthma Immunol Res. 2012;4:251-263; available at www.ncbi.nlm.nih.gov/pmc/articles/PMC3423598/, accessed May 15, 2014). The recommended next line of treatment for AOM is clindamycin (Cleocin) (Pediatrics. 2013;131:e964-e999; available at pediatrics.aappublications.org/content/131/3/e964.full, accessed June 11, 2014).—Julee B. Waldrop, DNP (188-1)

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