JffLactam Antibiotics

Hypersensitivity reactions with ^-lactam antibiotics, especially penicillin, may encompass any of the Type I through IV Gell-Coombs classifications. The most common

reactions are maculopapular and urticarial eruptions. While rare (lesser than

0.05%), anaphylaxis to penicillins cause the greatest concern, as they are responsible for the majority of all drug-induced anaphylaxis deaths in patients, accounting for 75% of all anaphylaxis cases in the United States.5,8 The treatment of anaphylaxis is given in Table 54-3.9

Table 54-2 Problematic Drug Classes

ß-Lactam antibiotics Sulfonamide antibiotics

Aspirin and nonsteroidal anti-inflammatory drugs

Radiocontrast media

Opiates

Chemotherapy

Insulin

Anticonvulsants

Table 54-3 Pharmacologic Management of Anaphylactic Reactions

Immediate Intervention Epinephrine 1:1,000 (1 mg/mL)

• Adults: Give 0.2-0.5 mg intramuscular (IM) or subcutaneous (SC); repeat every 5 minutes as needed

• Pediatrics: 0.01 mg/kg (maximum 0.3 mg) IM or SC, repeat every 5 minutes as needed

Subsequent Interventions

Normal Saline Infusion

• Adults: 1-2 L at a rate of 5-10 mL/kg in the first 5 minutes, followed by slow infusion

• Pediatrics: up to 30 mL/kg in the first hour Epinephrine Infusion

If patient is NOT responding to epinephrine injections and volume resuscitation:

• Adults: epinephrine infusion (1 mg in 250 mL dextrose 5% in water [D5W]): 1-4 mcg/min, titrating based on clinical response or side effects

• Pediatrics: epinephrine 1:10,000 (0.1 mg/mL): 0.01 mg/kg (up to 0.3 mg) over several minutes

Other Considerations after Epinephrine and Fluids Diphenhydramine

• Pediatrics: 1-1.25 mg/kg (maximum of 300 mg/24 hour) Ranitidine

• Pediatrics: 1 mg/kg (up to 50 mg) in D5W 20 mL IV over 5 minutes

Inhaled ^-agonist (bronchospasm resistant to epinephrine) 2-5 mg in 3 mL of normal saline, nebulized, repeat as needed

Dopamine (hypotension refractory to fluids and epinephrine) 2-20 mcg/kg/min titrated to maintain systolic blood pressure greater than 90 mm Hg

Hydrocortisone (severe or prolonged anaphylaxis)

• Adults: 250 mg IV (prednisone 20 mg can be given orally in mild cases)

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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