What is the treatment for a drug reaction rash caused by Amoxicillin (amoxicillin) in a 14-month-old child who is otherwise healthy?

From the Guidelines

The treatment for a drug reaction rash caused by Amoxicillin in a 14-month-old child who is otherwise healthy is to stop the medication and monitor for any further reactions, as the rash is likely a benign cutaneous eruption.

Treatment Approach

• The child's reaction is likely a maculopapular exanthem, which is a common and benign side effect of amoxicillin, especially in children with concurrent viral infections 1.
• Penicillin skin testing may be considered, but it is not necessary in this case, as the reaction is likely not an allergic one 1.
• Single-dose amoxicillin challenge without prior allergy testing may be recommended if the reaction was mild and not accompanied by systemic symptoms, but this should be done under medical supervision 1.

Management

• Discontinue amoxicillin and monitor the child for any further reactions or worsening of symptoms.
• Provide supportive care, such as antihistamines or topical corticosteroids, to alleviate any discomfort or itching associated with the rash.
• Reassess the need for antibiotics and consider alternative treatments if necessary.

Important Considerations

• Resensitization to penicillin is rare, but it can occur, especially after repeated or parenteral exposures 1.
• Penicillin allergy testing and delabeling can be considered in patients with a history of penicillin allergy, but it should be done under medical supervision and with careful consideration of the patient's medical history and current symptoms 1.

From the FDA Drug Label

If an allergic reaction occurs, amoxicillin should be discontinued, and appropriate therapy instituted. If patients develop skin rash they should be monitored closely, and amoxicillin discontinued if lesions progress.

The treatment for a drug reaction rash caused by Amoxicillin in a 14-month-old child who is otherwise healthy is to:

• Discontinue amoxicillin
• Institute appropriate therapy for the allergic reaction or skin rash, however the specific therapy is not defined in the label 2 2

From the Research

Treatment for Amoxicillin-Induced Rash in a 14-Month-Old Child

• The treatment for a drug reaction rash caused by Amoxicillin in a 14-month-old child who is otherwise healthy is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, the studies suggest that the management of amoxicillin-associated reactions (AARs) in children typically involves treating the symptoms, such as rash and fever, with medications like cetirizine and prednisone 6.
• In some cases, children with AARs may require treatment with corticosteroids, especially if they exhibit "worrisome" features like fever, angioedema, or gastrointestinal symptoms 7.
• The studies also highlight the importance of correctly characterizing adverse drug reactions to prevent unnecessary avoidance of the triggering agent and improve patient management 6, 7.

Diagnostic Considerations

• The diagnosis of AARs in children can be challenging, and a thorough clinical history and subsequent appropriate diagnostic testing, including medication challenge, can help establish the diagnosis 5.
• The studies suggest that the absence of eosinophilia, low RegiSCAR score, confirmation of viral etiology, and rapid resolution of the rash may help to rule out DRESS syndrome in children with AARs 4.
• Penicillin skin testing may also be used to assess the likelihood of an allergic reaction to amoxicillin, although the results may not always be conclusive 6.

Clinical Features and Chronology

• The studies describe the clinical features and chronology of AARs in children, including the typical onset of symptoms on days 7 to 10 of amoxicillin treatment 7.
• The most common symptoms of AARs in children include urticaria, maculopapular exanthem, and serum sickness-like reactions, with some children exhibiting "worrisome" features like fever, angioedema, or gastrointestinal symptoms 7.