zithromax and Drug-Hypersensitivity

The macrolides are generally well tolerated when used for the treatment of acute infections. Even when given long term for prophylaxis, there are few discontinuations due to side-effects. There are isolated reports of QT(c) prolongation in patients treated with erythromycin and other 14-membered-ring macrolides. Since the 14-membered-ring macrolides are metabolized by P450 isoenzymes, there is the potential for interaction with other therapeutic agents also metabolized in this way. Pharmacokinetic studies have demonstrated interactions between either erythromycin or clarithromycin and cyclosporin, cisapride, pimozide, disopyramide, astemizole, carbamazepine, midazolam, digoxin, hydroxymethylglutaryl-coenzyme A reductase inhibitors (i.e. 'statins') and warfarin. In patients receiving such concurrent therapy, azithromycin may be superior to erythromycin and clarithromycin.

Topics: Anti-Bacterial Agents; Azithromycin; Dose-Response Relationship, Drug; Drug Hypersensitivity; Drug Interactions; Erythromycin; Humans; Time Factors

The macrolides are a well established group of antibacterials frequently used in general practice. The most frequently used macrolides in paediatric patients are erythromycin, a naturally occurring compound, and clarithromycin and azithromycin, recently developed macrolides. Overall adverse effect rates of 7 to 26% for erythromycin, 14 to 26% for clarithromycin, and 6 to 27% for azithromycin have been described in children. Adverse gastrointestinal effects, including nausea, vomiting, diarrhoea and abdominal cramps, are the most common problems in children. Allergic reactions, hepatotoxicity, ototoxicity and adverse effects involving the central and peripheral nervous systems have also been observed in children. Stevens-Johnson, Schonlein-Henoch and Churg-Strauss syndromes have been rarely described in children. Treatment-related laboratory abnormalities have been recorded in 2 to 4% of erythromycin- and in 0 to 1% of both clarithromycin- and azithromycin-treated children. Elevation in liver function tests was the most common abnormality cited. Increased macrolide use in children in recent years has resulted in a growing potential for drug interactions between them and other pharmacologically active agents via the inhibition of cytochrome P450 (CYP) microsomal enzymes. Drug interactions with theophylline, cyclosporin, carbamazepine, terfenadine and warfarin limit erythromycin use. Clarithromycin is a weak inducer of CYP and exhibits fewer drug-drug interactions than erythromycin. However, its use with theophylline, carbamazepine and terfenadine is contraindicated. In contrast, no significant interactions have been reported with azithromycin to date. Macrolides have been proven to be well tolerated in the treatment of upper and lower respiratory tract infections, skin and soft tissue infections, and also in less frequent infections occurring in paediatric patients. In addition, clarithromycin and azithromycin have shown good tolerability profiles in immunocompromised paediatric patients. In conclusion, macrolides antibacterials have proven to be well tolerated in paediatric patients. Although the incidence of adverse effects is similar with the use of erythromycin and the newer macrolides, drug interactions occur significantly less when clarithromycin or azithromycin are administered.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Child; Clarithromycin; Drug Hypersensitivity; Drug Interactions; Erythromycin; Humans; Liver Function Tests

In the first wave of COVID-19, up to 20% of patients had skin lesions with variable characteristics. There is no clear evidence of the involvement of the SARS-CoV-2 virus in all cases; some of these lesions may be secondary to drug hypersensitivity. To analyze the possible cause of the skin lesions, we performed a complete allergology study on 11 patients. One year after recovery from COVID-19, we performed a lymphocyte transformation test (LTT) and Th1/Th2 cytokine secretion assays for PBMCs. We included five nonallergic patients treated with the same drugs without lesions. Except for one patient who had an immediate reaction to azithromycin, all patients had a positive LTT result for at least one of the drugs tested (azithromycin, clavulanic acid, hydroxychloroquine, lopinavir, and ritonavir). None of the nonallergic patients had a positive LTT result. We found mixed Th1/Th2 cytokine secretion (IL-4, IL-5, IL-13, and IFN-γ) in patients with skin lesions corresponding to mixed drug hypersensitivity type IVa and IVb. In all cases, we identified a candidate drug as the culprit for skin lesions during SARS-CoV-2 infection, although only three patients had a positive drug challenge. Therefore, it would be reasonable to recommend avoiding the drug in question in all cases.

Topics: Azithromycin; COVID-19; COVID-19 Testing; Cytokines; Drug Hypersensitivity; Humans; Lymphocyte Activation; SARS-CoV-2

Antibiotic allergy is a big problem that may affect the treatment and life quality of patients with cystic fibrosis (CF).. To evaluate predictive factors for confirmed antibiotic hypersensitivity in children with CF.. In this case-controlled study, we examined 15 patients with CF who had been confirmed with antibiotic allergy. Additionally, we included a control group of age- and gender-matched 45 CF patients with no antibiotic allergy. The diagnosis of antibiotic allergy was confirmed in the presence of a compatible history and a positive response in the drug skin test or provocation test. Multiple drug hypersensitivity was classified according to the temporal relationship of antibiotics: (i) distant, (ii) simultaneous, and (iii) sequential. The data were analyzed by conditional logistic regression.. β-lactam allergy was confirmed in eight patients (ceftazidime n = 5, piperacillin-tazobactam n = 3) and non-β-lactam allergy was confirmed in two patients (ciprofloxacin n = 1, azithromycin n = 1). Additionally, multiple drug hypersensitivity in five patients (distant n = 4, sequential n = 1), among whom two patients showed hypersensitivity against ceftazidime/piperacillin-tazobactam+ ciprofloxacin/levofloxacin, two patients showed hypersensitivity against ceftazidime+ ciprofloxacin n = 2, and one patient showed hypersensitivity against piperacillin-tazobactam+ amikacin+ trimethoprim-sulfamethoxazole. All patients (n = 13) with confirmed β-lactam allergy were meropenem tolerant. Multivariate analysis indicated that immediate reactions (, p < 0.001) and allergic evaluation in the first six months after the reaction (p = 0.036) were significant risk factors for the prediction of antibiotic hypersensitivity.. Beta-lactam antibiotic allergy is the most commonly confirmed drug allergy in children with CF. However, unlike normal children, ceftazidime and piperacillin-tazobactam account for the majority.

Topics: Amikacin; Anti-Bacterial Agents; Azithromycin; Case-Control Studies; Ceftazidime; Child; Ciprofloxacin; Cystic Fibrosis; Drug Hypersensitivity; Humans; Levofloxacin; Meropenem; Piperacillin; Retrospective Studies; Tazobactam; Trimethoprim, Sulfamethoxazole Drug Combination

Macrolides are considered safe antibiotics with reduced allergenic activity. However, studies on the safety of macrolides are scarce, particularly in children.. The aim of this study was to assess the frequency of hypersensitivity reactions to clarithromycin and azithromycin in a group of children referred to our allergy unit for suspected macrolide allergy.. We retrospectively reviewed the charts of 90 children aged 1-17 years with symptoms suggestive of hypersensitivity reaction to clarithromycin or azithromycin between December 31, 2008 and December 31, 2013. The allergy workup included skin tests (ie, skin prick tests and/or intradermal tests), determination of serum specific IgE (sIgE) to clarithromycin and azithromycin, and, if necessary to reach a diagnosis, oral provocation tests.. Seventy-seven children completed the allergy workup. A reaction to clarithromycin was recorded in 58 children (75.3%): 21 (36.2%) had a history of immediate reactions, and 37 (63.8%) had a history of nonimmediate reactions. A reaction to azithromycin was recorded in 19 children (24.6%): 6 (31.5%) had a history of immediate reaction, and 13 (68.42%) had a history of nonimmediate reaction. Positive results in skin tests and oral provocation tests with the suspect drug confirmed the diagnosis in 15.5% of reactions to clarithromycin (9 of 58) and in 47.3% of reactions to azithromycin (9 of 19) (P = .004).. A complete allergy workup enabled us to confirm a diagnosis of clarithromycin and azithromycin allergy in 15.5% and 47.3% of cases, respectively. Azithromycin was more allergenic than clarithromycin in children.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Azithromycin; Biomarkers; Child; Child, Preschool; Clarithromycin; Drug Hypersensitivity; Female; Humans; Immunoglobulin E; Infant; Intradermal Tests; Italy; Male; Predictive Value of Tests; Retrospective Studies; Risk Factors

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Clarithromycin; Desensitization, Immunologic; Dose-Response Relationship, Immunologic; Drug Hypersensitivity; Female; Humans; Mycobacterium avium; Treatment Outcome; Tuberculosis

Topics: Anti-Bacterial Agents; Azathioprine; Azithromycin; Drug Hypersensitivity; Drug Therapy, Combination; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Myocarditis; Prednisone

Adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1%. We describe a 29-year-old woman admitted with a history of itching, rash, vesicles on her hands and soles, and edema on her tongue and oropharynx after trimethoprim-sulfamethoxazole, ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin, and ceftriaxone intake. Erythema multiforme (EM) was diagnosed by skin biopsy after oral challenge with piroxicam. EM lesions reappeared after oral challenge with levofloxacin. Although EM is quite common with trimethoprim-sulfamethoxazole and there are some reports of EM appearing after intake of ciprofloxacin, it has rarely been attributed to piroxicam and no reports have identified levofloxacin as a cause.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Hypersensitivity; Erythema Multiforme; Female; Humans; Levofloxacin; Methenamine; Ofloxacin; Piroxicam; Skin Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Azithromycin; Bronchitis; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Humans; Male

Macrolides are known to have relatively few side effects and are prescribed in cases of allergic reaction to penicillin. The new macrolides, for example Azithromycin and Roxithromycin, are increasingly preferred over erythromycin at the ear, nose, and throat out-patient department due to improved oral reabsorption (acid resistance), better penetration into tissue, prolonged half-life, extended antibacterial activity, modest side effects, and better pharmacokinetics. There are only few case reports concerning side effects of macrolides. We report on the appearance of a Churg Strauss-Syndrome (CSS) in a patient following intake of the macrolide antibiotic azithromycin and roxithromycin.. A 50-year-old patient with asthma for three years presented with arthritis and mononeuritis multiplex. Laboratory and radiological investigations revealed eosinophilia (64%), eosinophilic infiltrations of bone marrow, raised IgE-level, and transient pulmonary infiltrates. THERAPY AND DEVELOPMENT: Intravenous steroid therapy was started and resulted in normalization of eosinophilia, IgE-level, and asthmatic symptoms. The neurologic deficits showed only a weak tendency for improvement.. The diagnosis of CSS was established on the basis of clinical criterias and laboratory investigations. The diagnosis was supported by the fact that a similar course of the disease was observed one year ago following administration of azithromycin, another macrolide.

Topics: Anti-Bacterial Agents; Asthma; Azithromycin; Churg-Strauss Syndrome; Drug Hypersensitivity; Ethmoid Sinusitis; Humans; Maxillary Sinusitis; Middle Aged; Recurrence; Retreatment; Roxithromycin