What alternative antibiotics can be used for patients allergic to polymyxin and sulfa, such as Amoxicillin (amoxil) or Azithromycin?

From the Guidelines

For patients allergic to polymyxin and sulfa, Amoxicillin (amoxil) or Azithromycin can be considered as alternative antibiotics, but the choice should be guided by the specific infection, severity, local resistance patterns, and the patient's medical history, as suggested by the most recent guideline 1. When considering alternative antibiotics for patients with allergies to polymyxin and sulfa, it's crucial to assess the severity of the allergy and the specific infection being treated.

• The patient's allergy history should be thoroughly verified to ensure safe prescribing.
• According to the Dutch Working Party on Antibiotic Policy (SWAB) guideline 1, a more liberal approach towards patients with suspected antibiotic allergy is supported, indicating that fewer than 10% of patients who report an antibiotic allergy are truly allergic.
• The risk of cross-reactivity, especially with cephalosporins like cefdinir or cefuroxime, is smaller than previously assumed, as noted in the Pediatrics study 1.
• Azithromycin can be a viable option for patients allergic to polymyxin and sulfa, given its different mechanism of action and lower risk of cross-reactivity.
• However, for patients with a severe penicillin allergy, caution should be exercised, and alternatives like macrolides or fluoroquinolones might be more appropriate, depending on the infection and local resistance patterns.
• The choice of antibiotic should always prioritize the patient's safety, the effectiveness of the antibiotic against the specific pathogen, and the minimization of antibiotic resistance risk, as emphasized by the guideline 1.

From the FDA Drug Label

Amoxicillin is contraindicated in patients who have experienced a serious hypersensitivity reaction (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin or to other β-lactam antibacterial drugs (e.g., penicillins and cephalosporins). There is no information about polymyxin or sulfa allergy in the provided drug labels for Amoxicillin or Azithromycin. Key points:

• The provided drug labels do not mention polymyxin or sulfa allergies.
• Amoxicillin is a β-lactam antibacterial drug, and patients with a history of hypersensitivity to penicillins or cephalosporins should not take it.
• Azithromycin is a macrolide antibacterial drug, and its label does not mention polymyxin or sulfa allergies. The FDA drug label does not answer the question.

From the Research

Alternative Antibiotics for Patients Allergic to Polymyxin and Sulfa

• Patients allergic to polymyxin and sulfa can be considered for alternative antibiotics such as Amoxicillin (amoxil) or Azithromycin, depending on the specific allergy history and the infection being treated 2, 3, 4.
• A detailed allergy history is crucial in determining the best course of treatment, as some patients may have a low-risk history and can tolerate certain antibiotics, while others may have a high-risk history and require more caution 3.
• Azithromycin has been shown to be safe in patients allergic to penicillin and cephalosporin, with no reactions reported in a study of 48 patients 4.
• However, it's essential to note that each patient's allergy history and medical condition should be evaluated individually, and the decision to use a particular antibiotic should be made by a healthcare professional 2, 3, 5.
• There is limited evidence to support broad cross-allergenicity between sulfonamide antibiotics and nonantibacterial sulfonamides, suggesting that patients with a sulfa allergy may not be at increased risk of adverse reactions to nonantibacterial sulfonamides 6.

Considerations for Antibiotic Use

• The use of broad-spectrum antibiotics should be avoided when possible, as it can increase the risk of antimicrobial resistance and adverse events 3.
• Patients with a history of allergy to polymyxin and sulfa should be closely monitored for any signs of an allergic reaction when given alternative antibiotics 2, 3.
• The goals of antimicrobial stewardship should be considered when selecting antibiotics, with the aim of using the most effective and safest treatment option for each patient 3.