Amoxicillin (INN), formerly amoxycillin (BAN), abbreviated Amox,Tormoxin (in India), is a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat infections caused by bacteria, such as ear infections, bladder infections etc.
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Skin rash in infants and young children being treated with amoxicillin alone or in combination with clavulanic acid is rarely due to an allergy to the antibiotic therapy, researchers said here at the 29th Congress of the European Academy of Allergy and Clinical Immunology (EAACI).
"In most cases, children who consult because they have had a rash aren't allergic," said Maria Ascension Aranzábal Soto, MD, Hospital de Zumárraga, Zumárraga, Spain, on June 8.
Dr. Soto presented the findings of a study of 56 children who developed skin rashes during antibiotic treatment with amoxicillin or amoxicillin-clavulanic acid and were referred for full allergologic work-up during 2008.
Thirty boys and 26 girls aged 6 years or younger were evaluated. Of these, 32 were taking amoxicillin alone and 24 were taking amoxicillin-clavulanic acid. All but 1 of the children had experienced skin rashes more than 1 hour after the first dose of antibiotic had been given.
The 1 child that had experience an immediate rash -- defined as a rash occurring within 1 hour of the first antibiotic dose -- had been given amoxicillin alone.
"54 challenge tests were performed and 52 children had negative results," Dr. Aranzábal Soto reported.
This meant that 93% of the 56 children studied were not allergic to either amoxicillin or to amoxicillin-clavulanic acid.
The findings are important, Dr. Aranzábal Soto said, as amoxicillin is an inexpensive, nontoxic, and commonly used antibiotic, and means that children can continue to be treated after confirming that they are not allergic.
Other data, however, show that a significant number of young children are allergic to clavulanic acid but not to amoxicillin.
"There are many patients who take amoxicillin with clavulanic acid and in the allergic evaluation only sensitivity to amoxicillin is tested," said Cristobalina Mayorga, MD, Carlos Haya Hospital, Malaga, Spain, on June 8 while presenting findings from a similar study.
"So there are many patients who are classified as nonallergic because they are negative to amoxicillin but they are may be positive to clavulanic acid," Dr. Mayorga said.
Their study included 55 children who had experienced an immediate allergic reaction to amoxicillin-clavulanic acid and had positive skin prick tests to betalactam derivatives. A control group of 30 children with good tolerance to the antibiotic combination and negative skin prick tests for benzylpenicillin, benzylpenicilloyl-polylysine, amoxicillin, and clavulanic acid were also studied.
Nine percent of patients had positive skin prick tests to major and/or minor determinants of benzylpenicillin whether they were positive or not to amoxicillin, Dr. Mayorga reported.
Amoxicillin alone caused a reaction in 62% of children, but 29% of children had a positive skin test to clavulanic acid in the absence of other positive findings.
"This indicates the need to test with clavulanic acid alone when evaluating subjects with immediate hypersensitivity reactions to the amoxicillin-clavulanic acid combination," Dr. Mayorga concluded.
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