amoxicillin-potassium-clavulanate-combination and Anaphylaxis

Anaphylaxis is a severe acute multisystem syndrome involving massive mediator release from mast cells and basophils. Although the entire arterial system can be affected, when coronary arteries are the main targets, Kounis syndrome needs to be considered. Cerebral artery involvement has also been suggested in rarer MC-mediator release episodes; so-called 'Kounis-like' syndrome. Cerebral ischaemic lesions can then result from low blood pressure or direct proinflammatory and/or vasoconstrictive mediator action in the cerebral arterial system. Diagnosis can be difficult in anaesthetised patients, as low blood pressure can have multiple causes. Treatment is also challenging, as administering adrenaline can worsen ischaemia. We report the first case of amoxicillin-clavulanic acid-induced type II Kounis syndrome under general anaesthesia, complicated with severe, irreversible and subsequently fatal encephalopathy of ischaemic origin. This case can contribute to awareness of less common Kounis syndrome manifestations, including severe cerebral involvement, or other anaphylactic reactions with atypical presentations.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anesthesia, General; Humans; Hypoxia-Ischemia, Brain; Kounis Syndrome

Anaphylaxis represents a systemic disease occurring after the exposure to an allergen. Drugs for the treatment of anaphylactic reactions (ie, corticosteroids and adrenalin) could induce autonomic alterations, such as tachycardia, hyperthermia, tachypnoea and leucocytosis. We describe the case of a 52-year-old woman presenting with a severe allergic reaction after the ingestion of amoxicillin-clavulanate. The occurrence of ECG alterations, laboratory abnormalities and procalcitonin (PCT) elevation will be discussed with particular emphasis on the possible misleading role of PCT during anaphylactic shock.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Anti-Inflammatory Agents; Clarithromycin; Electrocardiography; Female; Humans; Hydrocortisone; Middle Aged; Procalcitonin

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Humans

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Excipients; Humans; Skin Tests

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Humans

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Clavulanic Acid; Humans

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Chest Pain; Coronary Occlusion; Epinephrine; Humans; Hydrocortisone; Kounis Syndrome; Male; Middle Aged; Percutaneous Coronary Intervention

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Middle Aged

Topics: Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Drug Hypersensitivity; Fatal Outcome; Female; Humans; Kounis Syndrome; Middle Aged; Stents; Thrombosis

Kounis syndrome (KS) is characterized by concurrent presence of anaphylactic and cardiac components. Available evidence suggests that antibiotics are frequently associated to KS. We therefore analyzed KS cases associated with antibiotics use from the two largest pharmacovigilance databases.. Two pharmacovigilance databases, EudraVigilance and VigiLyze, were searched for cases reporting the adverse reaction "Kounis Syndrome" with antibiotics as suspected active substance. We analyzed the period from December 1st, 2001 to February 16th, 2016. For the most reported active substance, proportional reporting ratio (PRR) was calculated.. A total of 10 cases of KS associated with antibiotic use were retrieved from EudraVigilance database. Mean patients' age was 58.2years and 70% were male. The most frequently reported suspected antibiotic was the combination amoxicillin/clavulanic acid (four cases). VigiLyze database reported 13 KS cases associated to antibiotics. Mean age was 56years and 61% of patients were male. The most frequently reported antibiotic was again the combination amoxicillin/clavulanic acid (five cases). Seven duplicate cases were identified, leaving a total of 16 cases of KS, with six of them associated to amoxicillin/clavulanic acid use. The PRR value for amoxicillin/clavulanic acid against other kinds of antibiotics was 2.62 considering EudraVigilance data and 1.61 considering VigiLyze data.. This analysis provided a complete picture of the cases of KS associated with antibiotic use and identified a possible association between amoxicillin/clavulanic acid and KS. Since the number of cases is low, especially considering its wide use, further analyses are needed to confirm the association.

Topics: Acute Coronary Syndrome; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Coronary Vasospasm; Databases, Factual; Female; Glucocorticoids; Histamine Antagonists; Humans; Male; Middle Aged; Pharmacovigilance; Rare Diseases; Syndrome

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Clavulanic Acid; Drug Hypersensitivity; Epinephrine; Humans; Hypersensitivity, Delayed; Male; Treatment Outcome

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Female; Humans; Middle Aged; Ventricular Fibrillation

Topics: Acute Coronary Syndrome; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Female; Humans; Middle Aged

A patient suffered a myocardial injury as a manifestation of anaphylactic reaction to amoxicillin-clavulanic acid administration. A cardiologic study (ergometry and catheterization) showed no obstructive coronary disease and prick test to amoxicillin was positive. Anaphylaxis may cause myocardial injury and the mechanism is likely to be vasospasm induced by mast cells and basophil mediators.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Anti-Bacterial Agents; Drug Hypersensitivity; Humans; Male; Myocardial Ischemia

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anaphylaxis; Clavulanic Acids; Drug Hypersensitivity; Drug Therapy, Combination; Female; Humans; Penicillins