Typing Safe Antibiotics in Amoxicillin Hypersensitive Patients—Development of a Stepwise Protocol

Introduction: A history of an adverse reaction to amoxicillin, irrespective of the mechanism involved, significantly elevates patients’ anxiety and affects therapeutic decisions in the future, leading to unnecessary avoidance of antibiotics. As a consequence, it would be useful to find a safe and reliable protocol for typing safe alternative antibiotics. The aim of the study was to determine negative predictive value of typing safe antibiotic in patients with a history of hypersensitivity reaction to amoxicillin. Material and methods: 71 patients, aged 20−83, with a history of an adverse reaction to amoxicillin were retrospectively analysed. On the basis of the reaction type they were divided into three groups: A—symptoms not typical for hypersensitivity reactions, B—allergy manifested by urticaria and/or angioedema, C—anaphylaxis. In group A amoxicillin was tested, in group B—cefuroxime, and in group C—macrolide: azithromycin or clarithromycin. Telephone follow-up visits were performed twice: 6−12 months and 3−5 years after the clinical assessment to evaluate tolerance of antibiotics. On the basis of the follow-up results, the negative predictive value (NPV) of the protocol was calculated. Results: The full diagnostic protocol was applied in 62 participants. Amoxicillin was found safe in 22, cefuroxime—in 21 and macrolide—in 19 patients. No anaphylactic reactions were observed during the tests. On the basis of the telephone follow-up, the NPV of the protocol was 96% in the first follow-up and 97% in the second one. Conclusion: A stepwise approach including SPTs, ICTs and provocations with amoxicillin / cefuroxime/macrolide—depending on a patient’s history—is safe and allows typing an antibiotic in the vast majority of patients.