Saturday, April 24, 2021

Ampicillin-rash in infectious mononucleosis


Penicillins such as amoxicillin and ampicillin are currently not recommended in patients with infectious mononucleosis with bacterial secondaries (streptococcal tonsillo-pharyngitis). Why?

It has been evidenced that about 25-70% of patients with IM who were given antibiotics such as penicillins, clarithromycin, or cefixime developed maculopapular exanthems on skin which even worsened, in some cases, to erythroderms.

Mechanism - ?allergic sensitization.

Immediate (type-I) + Delayed (type-IV) of HSR. - secretion of IgE + IgG4 by B-cells, and production of IL-4, IL-5 and IL-13 by Th2 T-cells leading to eosinophilic inflammatory response.

It is thus advised to perform in vivo allergy tests prior to administration of penicillins in IM.

That's all

- Jaskunwar Singh

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