Amoxycillin Induced Anaphylactic Shock: A Case Report

V. Mariammal1, D. Suryaprabha2

1Senior Executive-Clinical Pharmacist, Kauvery Hospital, Cantonment, Trichy, India

2Senior Executive-Clinical Research, Kauvery Hospitals, India

*Correspondence: Tel.: +91 98414 86267; email: suryaprabha@kauveryhospital.com

Background

Anaphylaxis is an acute, potentially life-threatening, generalized, or systemic allergic reaction that is mediated by the degranulation of mast cells and basophils. Drug hypersensitivity is one of the most frequent causes of anaphylaxis [1]. Beta-lactams are the most commonly prescribed antibiotics and are responsible for the majority of hypersensitivity reactions to drugs [2,3].

Case Presentation

A 55-years-aged female was brought to ER with drowsiness and itching all over the body after taking 1 tablet of amoxicillin 500 mg for upper respiratory tract infection, from an outside hospital, on OP basis.

Upon presentation to the Emergency Room patient responded only to painful stimuli and did not obey commands. BP was not recordable. The patient had a previous history of anaphylactic reaction to oral antibiotics about seven months earlier. The patient was diagnosed to have an anaphylactic shock. She received immediate intravenous adrenaline and responded.

Management

After stabilization at the Emergency Room, the patient was admitted to the intensive care unit. She was treated with IV fluids, Adrenaline infusion, Noradrenaline infusion, Inj. Hydrocortisone and antihistamines. Adrenaline and noradrenaline infusions were gradually tapered and stopped. Dyselectrolytemia was corrected appropriately. Her diabetes was managed with insulin. After blood pressure, the normalized patient was shifted to the ward for observation. She was discharged in stable condition; at the time of discharge her vitals were: BP, 130/80; PR, 88/min; SpO2, 99% in Room air and RR of 20/min.

Investigations

Echo normal, other reports were also normal

Discussion

Beta-lactams are the most frequent cause of antibiotic hypersensitivity, more specifically amoxicillin, alone or with clavulanic acid. The diagnosis is based on the development of the life-threatening symptoms of anaphylaxis after intake of amoxicillin. Immediate reactions that occur within the first hour of drug administration are characterized by urticaria, angioedema, rhinitis, bronchospasm, and anaphylactic shock.

Conclusion

The overall incidence and prevalence of allergic diseases is steadily on the rise. Amoxicillin is a frequently used antibiotic to treat bacterial infections, such as chest infections (including pneumonia). These cases illustrate that anyone administering amoxicillin should be aware of the risk of anaphylaxis, even in the absence of a history of prior reactions. They also demonstrate the catastrophic consequences of anaphylaxis to amoxicillin, with adverse outcomes that may occur despite timely intervention. Further investigation of the prevalence of medication-related anaphylaxis fatalities and advances in laboratory methods to aid the clinical diagnosis of such events are required.

References

  1. Simons FE, Ardusso LR, Bilí² MB, et al. Update: world allergy organization guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2011;12(4):389-99.
  2. Gomes ER, Brockow K, Kuyucu S, et al.; ENDA/EAACI Drug Allergy Interest Group. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy. 2016;71:149-61.
  3. Demoly P, Adkinson NF, Brockow K, et al. International consensus on drug allergy. Allergy. 2014;69:420-37.

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