Reduction in incidence of ampicillin rash by purification of ampicillin

Antibiotic-Induced Rash in Patients With Infectious Mononucleosis

Objective: To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM). Data Sources: A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms anti-bacterial agents and infectious mononucleosis. EMBASE (1980 to June 2016) was searched using the terms mononucleosis and antibiotic agent and drug eruption. References of all relevant articles were reviewed for additional citations and information. Study Selection and Data Extraction: We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years. Data Synthesis: We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic. Conclusion: A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.

Antigenicity of semisynthetic penicillin preparations to evoke systemic anaphylactic reactions in animal models

Four commercially available penicillin preparations (benzylpenicillin, aminobenzylpenicillin, carbenicillin and sulbenicillin) and two kinds of the new semisynthetic penicillin preparations (mezlocillin and piperacillin) evoked systemic anaphylactic reactions in guinea pigs immunized with one of the following penicillin-Ascaris extract (As) conjugates in aluminum hydroxide gel (alum), i.e., benzylpenicilloyl (BPO)-As, aminobenzylpenicilloyl (ABPO)-As, carbenicilloyl (CBPO)-As, sulbenicilloyl (SBPO)-As, mezlocillin-As conjugate (MEZ-As) and piperacillin-As conjugate (PIP-As). The tracheal chains prepared from the tracheas of the guinea pigs immunized with BPO-As, MEZ-As, or PIP-As revealed anaphylactic contractions in vitro on addition of benzylpenicillin, mezlocillin, or piperacillin preparations. These results indicated that the semisynthetic penicillin preparations as well as benzylpenicillin preparation have enough antigenicity to evoke systemic anaphylactic reactions in guinea pigs immunized with penicillin-As conjugate. Such guinea pigs seem to be suitable animals for investigations of penicillin allergy.

IgM and IgG antibody levels to ampicillin in patients with infectious mononucleosis

By means of a sensitive radio-immunoassay an antibody-like activity against ampicillin was detected in both IgM and IgG immunoglobulin classes of patients with infectious mononucleosis, being fifteen times the level (for IgM) and six and a half times the level (for IgG) of control subjects. Such ampicillin antibody occurred without obvious relation to prior therapy with ampicillin. This antibody which may originate in a similar manner to Paul-Bunnell antibody was nevertheless immunologically unrelated. The possibility is discussed that the ampicillin rash in infectious mononucleosis results from a disseminated reaction of the small blood vessels to circulating ampicillin-antibody complexes.

Temporary skin reactions to penicillins during the acute stage of infectious mononucleosis

During the acute stage of infectious mononucleosis (IM), 16 out of 19 patients have reacted to skin tests with ampicillin and/or benzylpenicillin or their derivatives. Two thirds reacted to ampicillin and less than half (10/19) to benzylpenicillin, or their derivatives. No reaction was observed with cloxacillin. The lack of reactivity in 3 of 7 patients and the circumstance that the frequency of reactions with the penicilloylated Escherichia coli proteins makes it likely that the greater reactivity to penicillins and in particular to ampicillin in IM is not due mainly to protein impurities, but chiefly to the antibiotic molecule as such. There was no definite relationship between reactivity and clinical involvement. After the acute stage, disappearance of skin reactivity was noted. Intracutaneous testing with penicillins may be used to monitor the increased cutaneous reactivity during acute IM, and it may be helpful when the acute stage is over to determine when a patient may use these antibiotics without side reactions.

Prospective study of ampicillin rash. Report of a collaborative study group

A multicentre prospective study of 933 patients being treated with ampicillin showed a rash incidence of 7.3%. The rash was commonest in women and patients suffering from viral infections. Most rashes were maculopapular and were not associated with features of true penicillin allergy. We conclude that the development of a maculopapular rash during or after treatment with ampicillin is not in itself a contraindication to future treatment with the penicillins.

The formation of antigenic polymers in aqueous solutions of -lactam antibiotics

Samples from concentrated aqueous solutions of β-lactam antibiotics were examined by gel filtration. The eluates were monitored by ultraviolet (uv) absorption and by passive cutaneous anaphylaxis (PCA) in guinea-pigs sensitized with appropriate antiserum raised in rabbits. The appearance of uv absorbing material, giving a positive PCA reaction, in fractions from the high molecular weight regions of the eluates from gel filtration of aged solutions was taken as evidence of antigenic polymer formation.