From the Guidelines
The child should be evaluated by a healthcare provider immediately as this rash may represent an allergic reaction to the antibiotics, and the Clavulin (amoxicillin-clavulanate) should be stopped right away. The rash is likely due to the amoxicillin component in both medications, as Clavulin contains amoxicillin plus clavulanic acid 1. While waiting for medical attention, an age-appropriate dose of an antihistamine like diphenhydramine (Benadryl) can be given if available to help with symptoms. It is crucial to watch closely for any signs of a severe allergic reaction such as difficulty breathing, swelling of the face or lips, or extreme lethargy, which would require emergency care.
The healthcare provider will need to document this reaction as a potential penicillin allergy and prescribe an alternative antibiotic from a different class to treat the ear infection. According to the guidelines for the diagnosis and management of acute otitis media, alternative treatments for patients with a penicillin allergy include cefdinir, cefuroxime, or ceftriaxone, which are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 1. In the future, all penicillin-class antibiotics should be avoided until proper allergy testing can be done, typically when the child is older.
Key considerations in managing this patient include:
- Stopping the current antibiotic regimen immediately
- Providing symptomatic relief with antihistamines if necessary
- Monitoring for signs of severe allergic reactions
- Documenting the potential penicillin allergy
- Prescribing an alternative antibiotic from a different class
- Avoiding penicillin-class antibiotics in the future until allergy testing is performed.
From the Research
Allergic Reaction to Amoxicillin-Clavulanate
- The baby's rash after taking amoxicillin and then clavulin may be an allergic reaction to one or both of the medications 2, 3.
- Amoxicillin and clavulanic acid are commonly used antibiotics, but they can cause adverse reactions, including allergic reactions 2.
- A study found that patients can react to both amoxicillin and clavulanic acid simultaneously, with some patients developing IgE-mediated reactions and others developing T-cell-mediated reactions 3.
Management of Allergic Reactions
- An acute allergic reaction is a rapid-onset, IgE-mediated hypersensitivity reaction that can cause symptoms ranging from mild urticaria and swelling to respiratory collapse 4.
- The management of allergic reactions and anaphylaxis in the emergency department involves the use of epinephrine, corticosteroids, antihistamines, and other adjunctive therapies 4.
- In cases of suspected allergic reaction, it is essential to monitor the patient's airway and provide support as needed 4.
Next Steps
- The baby should be taken to the emergency department or a healthcare provider for evaluation and treatment of the allergic reaction 4.
- The healthcare provider may perform skin tests or other diagnostic tests to determine the cause of the allergic reaction 3.
- Treatment may involve the use of antihistamines, corticosteroids, or other medications to manage the allergic reaction 4.