From the Guidelines
I strongly recommend against ordering antihistamines PRN for this septic patient, and instead suggest considering intranasal corticosteroids or oral decongestants as needed, while closely monitoring the patient's condition and avoiding medications that could mask fever or cause excessive sedation. The patient's sepsis diagnosis takes precedence, and any treatment for allergic symptoms must be carefully weighed against potential risks to the patient's overall health. According to 1, oral antihistamines are generally effective in reducing rhinorrhea, sneezing, and itching associated with allergic rhinitis, but have little objective effect on nasal congestion. Given the patient's age (69 years) and sepsis diagnosis, it is crucial to prioritize treatments that will not exacerbate the patient's condition or interfere with sepsis management.
- Key considerations for treating allergic symptoms in septic patients include:
- Avoiding medications that could mask fever or cause excessive sedation
- Selecting treatments that will not interfere with sepsis monitoring
- Prioritizing intranasal corticosteroids or oral decongestants as needed, under close supervision
- Closely monitoring the patient's condition and adjusting treatment as necessary As noted in 1, second-generation antihistamines are generally preferred over first-generation antihistamines due to their lower risk of sedation and performance impairment, but even these may not be suitable for a septic patient without careful consideration of the potential risks and benefits.
From the FDA Drug Label
Uses • Temporarily relieves these symptoms due to hay fever or other respiratory allergies: • runny nose • sneezing • itchy, watery eyes • itching of the nose or throat
The patient's symptoms of nasal congestion and sneezing are consistent with the symptoms that diphenhydramine is used to relieve.
- The patient is 69 years old, and diphenhydramine can be used in adults.
- Antihistamines like diphenhydramine can be ordered PRN for allergic symptoms. Based on the information provided, diphenhydramine can be considered for the patient's symptoms, but the patient's sepsis should be taken into account when making the decision, and the patient's overall clinical condition should be evaluated before administering any new medication 2.
From the Research
Sepsis and Allergic Rhinitis
- The patient is experiencing symptoms of nasal congestion and sneezing, which they attribute to allergies 3.
- However, the patient is also diagnosed with sepsis, a life-threatening condition that requires immediate attention and treatment 4, 5.
Treatment of Sepsis
- The primary focus of treatment for sepsis is the administration of antimicrobials, which should be started as soon as possible, ideally within the first hour of diagnosis 4, 5.
- The choice of antimicrobials should be based on the local pathogen patterns of resistance, and individual antimicrobial optimization is essential to achieve adequate concentrations and reduce adverse effects 4.
- Corticosteroids may also be considered as part of the treatment for sepsis, as they have been shown to reduce mortality and improve outcomes in some patients 6, 7.
Treatment of Allergic Rhinitis
- For patients with allergic rhinitis, treatment options include second-generation H1 antihistamines, intranasal antihistamines, and intranasal corticosteroids 3.
- The choice of treatment should be based on the severity and frequency of symptoms, as well as patient preference 3.
Considerations for This Patient
- Given the patient's diagnosis of sepsis, the primary focus of treatment should be on addressing the underlying infection and managing the patient's symptoms 4, 5.
- While the patient's symptoms of nasal congestion and sneezing may be related to allergies, it is essential to prioritize the treatment of sepsis and ensure that any additional treatments, such as antihistamines, do not interfere with the patient's sepsis treatment 3.