Should penicillin (antibiotic) medication be discontinued in the event of a drug eruption?

From the Guidelines

Yes, penicillin should be stopped immediately if a drug eruption occurs. Drug eruptions are allergic reactions to medications that can range from mild rashes to severe, life-threatening conditions like Stevens-Johnson syndrome or anaphylaxis 1. Once a penicillin allergy is identified, the patient should be switched to an alternative antibiotic from a different class, such as macrolides (azithromycin, clarithromycin), fluoroquinolones (ciprofloxacin, levofloxacin), or tetracyclines (doxycycline), depending on the infection being treated. The healthcare provider should document this allergy clearly in the patient's medical record, and the patient should be advised to wear a medical alert bracelet or carry information about their penicillin allergy. The reason for stopping penicillin immediately is that continued exposure can lead to worsening reactions, as the immune system becomes increasingly sensitized to the drug. In some cases, after the acute reaction resolves, referral to an allergist for formal allergy testing may be appropriate, as some patients labeled as penicillin-allergic can actually tolerate these antibiotics upon retesting 1. It's also important to note that less than 5% of individuals labeled with a penicillin allergy are confirmed to have a true penicillin allergy, highlighting the need for proper diagnosis and documentation 1.

Key Considerations

• The prevalence of penicillin allergy is often overestimated, with less than 5% of labeled individuals having a confirmed allergy 1.
• Penicillin allergy testing and delabeling can improve antimicrobial stewardship and patient safety 1.
• Alternative antibiotics should be chosen based on the specific infection being treated and the patient's medical history 1.
• Clear documentation and communication of penicillin allergy status are crucial to prevent unnecessary avoidance of penicillins and ensure patient safety 1.

Recommendations

• Stop penicillin immediately if a drug eruption occurs.
• Switch to an alternative antibiotic from a different class.
• Document the allergy clearly in the patient's medical record.
• Advise the patient to wear a medical alert bracelet or carry information about their penicillin allergy.
• Consider referral to an allergist for formal allergy testing after the acute reaction resolves.

From the FDA Drug Label

IF AN ALLERGIC REACTION OCCURS, PENICILLIN V POTASSIUM SHOULD BE DISCONTINUED AND APPROPRIATE THERAPY INSTITUTED. The medication should be stopped if a drug eruption (allergic reaction) occurs while taking penicillin, and appropriate therapy should be instituted 2.

• Discontinuation of the medication is recommended in the event of an allergic reaction.
• Alternative therapy should be considered to manage the underlying condition.

From the Research

Penicillin Drug Eruption

• Penicillin is a type of beta-lactam antibiotic that can cause adverse reactions, including drug eruptions 3
• Drug eruptions are commonly known as adverse drug reactions involving the skin, and severe cases can be life-threatening 4
• Severe drug eruptions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), require immediate medical attention and can have a mortality rate of up to 50% 4, 5, 6, 7

Management of Penicillin Drug Eruption

• Immediate withdrawal of the potentially causative drug, in this case, penicillin, is crucial in managing severe drug eruptions 4, 5, 6, 7
• Supportive care is the most universally accepted intervention for SJS/TEN, and specific guidelines differ from the care required for patients with thermal burns 6
• Adjuvant therapies, such as systemic corticosteroids, intravenous immunoglobulin, and cyclosporine, may be used in severe cases, but the data is limited and underpowered 4, 5, 6

Treatment Strategies

• The treatment of SJS/TEN should be individualized, and decisions regarding adjuvant therapies should be made on a case-by-case basis 6
• A multidisciplinary approach is required for acute management, and early identification and proper management are critical to survival 4, 5, 7
• New biologics and plasma exchange are reasonable strategies to reduce mortality, but more research is needed to establish their efficacy 4, 6