amoxicillin-potassium-clavulanate-combination and Coronary-Vasospasm

Kounis syndrome (KS) is defined as concurrent acute coronary syndrome and allergic or hypersensitivity reactions. Despite being increasingly reported, it is still an underdiagnosed entity. Several medications are already known to result in KS. Amoxicillin/clavulanic acid is a frequently used antibiotic, and its use has been linked with KS. The aim of the present report was to draw attention to rare clinical manifestation of KS following peroral amoxicillin/clavulanate use.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Atrial Fibrillation; beta-Lactamase Inhibitors; Coronary Angiography; Coronary Vasospasm; Defibrillators, Implantable; Electrocardiography; Electroshock; Humans; Kounis Syndrome; Male; Middle Aged

Topics: Amoxicillin-Potassium Clavulanate Combination; Coronary Vasospasm; Defibrillators, Implantable; Drug Therapy, Combination; Humans; Hypersensitivity

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

The concurrence of acute coronary syndrome with allergy or hypersensitivity as well as with anaphylactic or anaphylactoid reactions is increasingly encountered in daily clinical practice. There are several reports associating mast cell activation with acute cardiovascular events in adults. This was first described by Kounis as 'allergic angina syndrome',progressing to 'allergic myocardial infarction'. The main mechanism proposed is the vasospasm of coronary arteries. We present a case of a 28-year-old man who was admitted to our hospital with thoracic pain and dyspnoea. The symptoms recurred after simultaneous use of 1 g amoxicillin/clavulanic acid orally and 1 g ampicillin/sulbactam parenterally for tonsillitis the night before presentation and on the morning of admission.

Topics: Acute Coronary Syndrome; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Angina Pectoris; Anti-Bacterial Agents; Coronary Angiography; Coronary Vasospasm; Drug Hypersensitivity; Electrocardiography; Humans; Injections, Intramuscular; Intradermal Tests; Male; Sulbactam; Tonsillitis

The association of an acute coronary syndrome with mast cell activation secondary to allergen exposure is known as the Kounis syndrome. We present two cases of the Kounis syndrome: (i) one was misdiagnosed as acute ST elevation myocardial infarction and treated with thrombolytics; (ii) the second diagnosis was made after a recurrence two months after the first incident.

Topics: Acute Coronary Syndrome; Adult; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Diagnosis, Differential; Drug Hypersensitivity; Female; Humans; Male; Mast Cells; Myocardial Infarction; Recurrence; Syndrome