From the Guidelines
No, a patient with a penicillin allergy should not take amoxicillin/potassium clavulanate (Augmentin) for pneumonia due to the risk of an allergic reaction. Amoxicillin is a type of penicillin antibiotic, and there is significant cross-reactivity between different penicillin drugs 1. Taking this medication when allergic to penicillin could trigger an allergic reaction ranging from mild rash to potentially life-threatening anaphylaxis.
The patient should contact their healthcare provider immediately to get an alternative antibiotic prescription. Common alternatives for treating pneumonia in penicillin-allergic patients include:
- Macrolides (like azithromycin)
- Fluoroquinolones (like levofloxacin)
- Tetracyclines (like doxycycline), depending on the specific type of pneumonia and its severity 1. The healthcare provider will need to know the nature and severity of the previous penicillin reaction to select the most appropriate alternative treatment. According to the Infectious Disease Society of America (IDSA) guidelines, macrolides are reserved for penicillin-allergic patients 1.
It's essential to consider the increasing resistance of S. pneumoniae to penicillin and other antimicrobial drugs, as reported in the study by the Infectious Diseases Society of America 1. However, this does not change the recommendation for a patient with a penicillin allergy, as the primary concern is the risk of an allergic reaction. The patient's healthcare provider will need to weigh the risks and benefits of different antibiotic options and choose the most appropriate treatment based on the patient's specific situation.
From the FDA Drug Label
5 WARNINGS AND PRECAUTIONS
- 1 Hypersensitivity Reactions Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving beta-lactam antibacterials, including amoxicillin and clavulanate potassium. These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens Before initiating therapy with amoxicillin and clavulanate potassium, careful inquiry should be made regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens.
Patients with a penicillin allergy should not take amoxicillin/potassium clavulanate (Augmentin) for pneumonia due to the risk of serious and potentially fatal hypersensitivity reactions, as stated in the drug label 2.
From the Research
Patient Considerations
- Patients with a reported penicillin allergy may not necessarily be allergic, as studies suggest that more than 90% of patients with reported penicillin allergy are not allergic 3.
- The rate of IgE-mediated penicillin allergies is decreasing, and cross-reactivity between penicillin and cephalosporin drugs occurs in about 2% of cases 4.
Antibiotic Treatment Options
- Amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that has been used to treat community-acquired respiratory tract infections, including pneumonia 5.
- However, patients with a documented penicillin and/or cephalosporin (P/C) allergy may be less likely to receive first-line beta-lactam antibiotic treatment, including amoxicillin/clavulanate, and may instead receive alternative antibiotics such as carbapenems or fluoroquinolones 3.
- For patients with a low-risk allergy history, a direct amoxicillin challenge may be appropriate, while moderate-risk patients can be evaluated with penicillin skin testing 4.
Safety and Efficacy
- Amoxicillin/clavulanate has a well-known safety and tolerance profile, and its efficacy in treating respiratory tract infections has been established 5.
- A study comparing the efficacy of amoxicillin/clavulanate with penicillin and gentamicin in treating severe hypoxemic pneumonia found that both treatments were equally effective 6.
- Clinicians should consider the patient's allergy history and the potential for cross-reactivity when selecting antimicrobial therapy 7.