Prescription Of Penicillin Research Articles

The Effect of the Pneumococcal Conjugate Vaccine on Children with Sickle Cell Disease

The Effect of the Pneumococcal Conjugate Vaccine on Children with Sickle Cell Disease

Is There Cross-Reactivity Between Penicillins and Cephalosporins?

Background We sought to determine the risk of an allergic reaction to a cephalosporin exposure in those with prior penicillin reactions. Methods We conducted a retrospective cohort study using the United Kingdom General Practice Research Database. We selected all patients receiving a prescription for penicillin followed by a prescription for a cephalosporin and identified allergic-like events within 30 days after each prescription. Allergic events were defined by 2 sets of codes: 1 more restrictive, 1 more inclusive. Comparison was made with a population of patients receiving a prescription for a penicillin followed by a prescription for a sulfonamide antibiotic. Results A total of 3 375 162 patients received a penicillin; 506 679 (15%) received a subsequent cephalosporin. Among patients receiving a penicillin followed by a cephalosporin, the unadjusted risk ratio of an allergic-like event for those who had a prior event, compared with those who had no such prior event, narrowly defined, was 10.1 (confidence interval 7.4-13.8). The absolute risk of anaphylaxis after a cephalosporin was less than 0.001%. The unadjusted risk ratio for sulfonamide antibiotic, rather than cephalosporin after penicillin allergic-like events was 7.2 (confidence interval 3.8-13.5). Conclusion Patients with allergic-like events after penicillin had a markedly increased risk of events after either subsequent cephalosporins or sulfonamide antibiotics. Cross-reactivity is not an adequate explanation for this increased risk, and the risk of anaphylaxis is very low. Thus, our data indicate that cephalosporins can be considered for patients with penicillin allergy.

Represcription of penicillin after allergic-like events

ObjectiveWe sought to determine the frequency of represcription of penicillin to individuals with penicillin allergy and the risk of a second reaction in those who had a previous reaction. MethodsA retrospective cohort study was conducted within the UK General Practice Research Database. All patients who had received a prescription for penicillin were identified. Within that source population, records of patients who had received at least 2 prescriptions for penicillin at least 60 days apart were selected and examined for allergic-like (hypersensitivity) events on the day of or within 30 days after a prescription. ResultsAt least one prescription for penicillin was given to 3,375,162 patients. Of 6212 (0.18%) patients who experienced an allergic-like event after the initial prescription, 48.5% were given a second prescription compared with 59.8% of those without an initial allergic-like event (risk ratio, 0.81; 95% CI, 0.79-0.83). Two or more prescriptions for penicillin were given to 2,017,957 patients. Three thousand fourteen (0.15%) patients experienced an allergic-like event after the first prescription, and 57 (1.89%) of those had another event after the second prescription. The unadjusted odds ratio of an allergic-like event after the second prescription for those who experienced an allergic-like event after the first prescription, compared with those who had no initial event was 11.2 (95% CI, 8.6-14.6). Adjusting for confounding had no substantive effect on this result. ConclusionThe risk of an allergic-like event after penicillin is markedly increased in those who have had a prior event, although the absolute difference is small (1.72%). Represcription of penicillin to such patients is more frequent than anticipated.

Re-prescription of penicillin in patients who have had allergic-like reactions: Investigation using a large electronic medical record

Rationale To determine the frequency of re-prescription of penicillin to penicillin-allergic individuals and the risk of a second reaction in those who had a previous reaction. Methods A retrospective cohort study was conducted within the UK General Practice Research Database, an electronic medical record. All patients who had received a prescription for penicillin, 1987 through 9/2001, and those who had received a second prescription for a penicillin at least 60 days later, were selected. Patients with events consistent with a hypersensitivity (allergic-like) reaction within 30 days after the first prescription were compared to those without such events. Results 3,375,162 patients received at least one prescription for penicillin. Of 6212(0.18%) who experienced an allergic-like reaction to the initial penicillin prescription, 48.5% were given a second prescription for penicillin, compared with 59.8% of those without an initial allergic reaction (OR 0.6, 95% CI 0.6, 0.7). 2,017,957 patients were given two or more prescriptions for penicillin. 3014 (0.15%) experienced an allergic-like reaction with the first prescription and 57 (1.89%) of those had another reaction after the second prescription. The unadjusted OR of an allergic-like reaction with the second prescription for those who experienced an allergic-like reaction following the first prescription, compared with those who had no initial reaction, was 11.2 (95% CI 8.6, 14.6). Adjusting for confounding had no substantive effect on this result. Conclusions The risk of an allergic-like reaction to penicillin is markedly increased in those who have had a prior event. Re-prescription of penicillin to such patients is more frequent than anticipated.

The prevalence of faecal carriage of ampicillin-resistant and high-level gentamicin-resistant enterococci among inpatients at 10 major Norwegian hospitals

From March to October 1999, 854 patients hospitalized at 10 major Norwegian hospitals were screened for rectal carriage of ampicillin-resistant enterococci (ARE) and high-level gentamicin-resistant enterococci (HLGRE). A total of 59 ARE carriers (prevalence 6.9%, range 0–22% among hospitals) and 28 HLGRE carriers (prevalence 3.3%, range 1–11%) were detected. All ARE or HLGRE strains were susceptible to vancomycin, whereas 77% of the ARE isolates were resistant to ciprofloxacin. All the ARE strains were identified as Enterococcus faecium, and 48% of these were genomically closely related as shown by PFGE. Specific point mutations in the pbp5 gene were associated with reduced susceptibility to ampicillin. The adjusted risk of becoming a carrier of ARE was related to the use of glycopeptides [odds ratio (OR) = 4.8], the use of any antimicrobial agent (OR = 3.1) and more than one hospital admission during the last six months (OR = 2.0). Twenty-five of 28 HLGRE isolates were Enterococcus faecalis. The aacA/aphD genes were detected in 26 (93%) and the aphA3 in 19 (68%) of the HLGRE isolates. Sixty-four percent of the HLGRE isolates belonged to two PFGE clusters. Consumption of antimicrobial agents was also a significant risk factor for HLGRE colonization (OR = 5.4), while prescription of penicillins was associated with reduced risk (OR = 0.28).

Group A Beta-hemolytic Streptococcal Infections

Group A Beta-hemolytic Streptococcal Infections

Posttraumatic facial swelling and draining sinus tract

The patient, a 32-year-old black man with a long psychiatric history, presented to the admitting area of the Omaha Veterans Hospital on May 2, 1990 after allegedly being struck in the face with a baseball bat. He said he had no loss of consciousness, visual changes, headache, nausea, or vomiting. In addition to left facial pain and swelling, the patient also complained of difficulty opening his mouth and a l-cm, fullthickness laceration of his right ear. Although he voluntarily presented to the admitting area with these injuries, he was described as being quite uncooperative, difficult to examine, and requiring the attendance of security personnel. He was subsequently admitted to the general medicine service and an ENT consultation was requested. Physical examination showed moderate left facial swelling over the left maxillary and temporal regions, left temporomandibular joint tenderness, and decreased interincisal opening. Cranial nerve seven was grossly intact. Oral examination showed an intact dentition. A panoramic radiograph and facial series showed normal facial bones, without evidence of fractures or dislocations. The cervical spine series was also normal. The patient refused any type of blood workup. Treatment recommendations were ice to the facial swelling and cleansing of the right ear laceration. On the second day of admission the patient was noted to have expectorated blood-tinged sputum, the cause of which was not determined because the patient decided to leave against medical advice and seek further medical treatment elsewhere. He was discharged with a prescription for oral penicillin, which he never had filled. The patient again presented to the admitting area on May 2 1, 1990 still complaining of left facial swelling, but now with a purulent discharge from a small external opening in the left nasolabial fold. A general surgery consultation was obtained and a diagnosis of buccal space abscess was made. An extraoral incision and drainage was completed without placement of a drain and the patient was given a prescription for penicillin 250 mg orally four times daily. He was instructed

Use of antibiotics in general practice in Denmark in 1987.

The worldwide usage of antibiotics is increasing making detailed information on prescribing patterns and intervention methods necessary. This investigation focused on the general practitioner's (GP's) usage of antibiotics in Denmark. Information on 7,607 patients treated by 602 GP's during 1 week in March 1987 were collected. The most commonly treated infectious diseases were upper respiratory tract infections (40%) and lower respiratory tract infections (17%). Penicillin was by far the most frequently prescribed antibiotic (44%), followed by antibiotics used locally (17%) and ampicillins (14%). Compared with previous investigations, this result indicated a relative increase in prescription of penicillin during recent years. The mean number of daily dosages was 2-3 and the duration of treatment 6-7 days, with ampicillin generally given 1 day longer than penicillin. The differences between prescribed daily dosages (PDD) found and defined daily dosages (DDD) ranged from + 40% to - 50%, making estimations of numbers of treated patients from total usage of antibiotics in DDD/1,000 inhabitants/day impossible.