Amoxicillin/clavulanic-acid

Abstract

Delayed hypersensitivity reaction: case report A 4-year-old girl developed delayed hypersensitivity reaction manifesting as disseminated maculopapular exanthema during treatment with amoxicillin/clavulanic-acid for suppurative otitis. Later, she again developed delayed hypersensitivity reaction manifesting as generalised maculopapular exanthema, wheals and erythema during intradermal testing with amoxicillin and amoxicillin/clavulanic-acid [dosages not stated]. The girl was admitted to a paediatric allergy clinic due to a suspicion of β-lactam antibiotic allergy (current presentation). Her mother reported that she was started on oral amoxicillin/clavulanic-acid [amoxicillin-clavulanate] in Decemer 2019 due to suppurative otitis. However, 7 days after the first dose (and about two hours after the last dose), she developed a disseminated maculopapular eruption. The girl was initially seen at the emergency department. At the emergency department, she received treatment with unspecified corticosteroids and antihistamines, with improvement of her symptoms. The amoxicillin/clavulanic-acid therapy was discontinued, and she was referred to the paediatric allergy clinic. She presented to the paediatric allergy clinic six months after the development of symptoms for evaluation (current presentation). Skin prick test performed with amoxicillin and amoxicillin/clavulanic-acid showed negative results at 15 minutes. Thereafter, intradermal tests was performed with full strength concentrations due to nonimmediate nature of reactions. Positive response was noted at 10 hours with both amoxicillin and amoxicillin/clavulanic-acid. She developed indurated wheals larger than 10×10mm in size with erythema along with gradual appearance of a generalised maculopapular exanthema that started in the upper trunk and lower limbs. She required treatment with unspecified corticosteroids and antihistamines. Subsequent clinical improvement was noted with complete resolution in 72 hours. Her parents were informed to use cefuroxime as the preferred antibacterial in case of infections.