Algorithm to identify patients at low risk for penicillin allergy

 
 

It is very likely this patient IS NOT allergic to penicillin. They should receive a single dose drug challenge to this medication.

INFORMED CONSENT:

95% of patients with this history that are challenged to amoxicillin tolerate it with no allergic symptoms.

  • 1% have hives only

  • 4% have a delayed (non dangerous) rash develop

Equipment in your community clinic you will need to manage this:

  • Epineprhine 0.01mg/kg, with a 25 gauge, 1 1/2 inch needle for administration into the lateral thigh if required

    or

  • Epineprhine autoinjector (EpiPen) 0.15mg and 0.3mg

Contraindications:

  • Currently on antihistamines (they will mask symptoms)

  • Vomiting more than once in the last 24 hours

  • Concerning respiratory symptoms (wheeze, needing O2)

  • Critically ill

  • Current Rash

  • NPO

Protocol:

Amoxicillin 15mg/kg orally (max dose for challenge of 250mg). Use oral chewable amoxicillin of 125mg/tablet or 250mg/tablet to reduce cost to family/clinic. You can round up to dosing as high as 30mg/kg to facilitate use of a chewable tablet. Tablet may be crushed, and mixed in water to improve taste if the child is picky). Parenteral administration should be avoided for this test dose.

Observe for 30-60 minutes. Was the dose well tolerated?

Yes

No, they had symptoms again


If instead you would like a clinical order set for an in hospital challenge, please click on the province you practice in:

BC