While these hypersensitivity reactions are uncommon, there have been an increasing number of case reports of AGEP related to clindamycin use.Ĭlindamycin does not cross-react with other antibiotics. Protocols for the desensitization for IV or inhalation tobramycin following an immediate hypersensitivity reaction are provided.Ĭlindamycin can be associated with delayed maculopapular exanthem, which appears as a rash 7 to 10 days following exposure and has a reported incidence as high as 10% and as low as 0.47% IgE–mediated anaphylactic reactions, which have rarely been reported following IV administration but have resulted in pulseless electrical activity requiring resuscitation in at least one case and other hypersensitivity reactions (fixed drug eruptions, DRESS, drug-induced hypersensitivity syndrome, symmetrical drug–related intertriginous and flexural exanthema, acute generalized exanthematous pustulosis, and acute febrile neutrophilic dermatosis or Sweet Syndrome). Caution is advised when testing for anaphylaxis with streptomycin since systemic reactions have been reported. However, if the SPT is negative, intradermal testing using nonirritating concentrations (i.e., 4 mg/mL of gentamicin and tobramycin or initial dose of 0.1-1 mg/mL of streptomycin) have been tried. Skin prick tests (SPTs) have confirmed immediate IgE–mediated hypersensitivity reactions. There are no validated skin tests to assess for immediate hypersensitivity reactions to aminoglycosides. On the other hand, cross-reactivity between streptomycin and other aminoglycosides is much lower at only 1% to 5% based on patch testing. While hypersensitivity reactions to aminoglycosides are uncommon and are limited primarily to case reports, cross-reactivity between deoxystreptamine-type aminoglycosides has occurred ( >50%) so that use of other drugs in this class are contraindicated following a severe reaction. Hypersensitivity reactions to aminoglycosides include allergic contact dermatitis (type IV hypersensitivity reactions), which can occur with topical administration IgE–mediated reactions, which have rarely been reported IV or IM gentamicin or intradermal streptomycin other hypersensitivity reactions (e.g., drug reaction with eosinophilia and systemic symptoms following the administration of neomycin or amikacin) and cross-reactivity. On the other hand, delayed hypersensitivity reactions occur 12 to 24 hours postexposure and can manifest as contact dermatitis or autoimmune hypersensitivity reactions.Ī recent review examined immediate- and delayed-hypersensitivity reactions associated with the use of aminoglycosides, clindamycin, linezolid, and metronidazole, which are some of the most common antibiotics used in the hospital or homecare setting.Īminoglycosides consist of two main structural groups: streptidine group (e.g., streptomycin) and the deoxystreptamine group (e.g., gentamicin, tobramycin, neomycin, amikacin, and plazomicin). This type of reaction is exemplified by anaphylaxis, allergic rhinoconjunctivitis, or urticaria. Immediate hypersensitivity reactions involve immunoglobulin E (IgE)–mediated release of histamine and other mediators from mast cells or basophils. Although antibiotics are life-saving medications, there are times when they can place a patient in a life-threatening situation due to the occurrence of hypersensitivity reactions.
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