What does an allergic reaction to antibiotics look like

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I had the pleasure of evaluating a 1-year-old female for an amoxicillin allergy. Mother shared her daughter had a cold for a week, but seemed to be getting better. She then developed a fever of 102. She was seen by her pediatrician the next day and was diagnosed with her first ear infection and started on amoxicillin twice a day. 

The patient was starting to get better, but then on the fifth day she woke up with a rash all over and her mother became concerned that her daughter was having an allergic reaction. Amoxicillin was stopped and her mother has been concerned about giving her the medication ever since.

About 5 to 10 percent of children taking amoxicillin or Augmentin will develop a skin rash at some point during the course of the medication. The majority of these reactions are non-allergic, and most are caused by viruses. So, how can you tell the difference?

A non-allergic rash occurring while taking amoxicillin or Augmentin will:

• Look like small (less than half an inch) widespread pink spots in a symmetrical pattern or slightly raised pink bumps
• Usually appear on day 5-7 from the start of the amoxicillin or Augmentin, but can occur at any time during the course of the medication
• It always appears on the chest, abdomen or back and usually involves the face, arms and legs - the rash may worsen before it gets better
• Differ from hives in appearance (hives are always raised, itchy and change location) 
• Usually goes away in three days, but can last from one to six days 
• It’s not contagious, so he/she can go back to school

Warning signs it is a true allergic reaction would be sudden onset of the rash within two hours of the first dose, any breathing or swallowing difficulty or very itchy hives.

Like the parent in the above scenario, even if you know it’s not an allergic reaction, it may still feel wrong to continue the medication or give it again in future. There are several reasons why it is better to continue using amoxicillin than stopping or changing to a different antibiotic:

• Changing to a broader-spectrum antibiotic may not be necessary and could cause other problems, such as diarrhea or vomiting. 
• Stopping the medication can incorrectly label your child as allergic to the penicillin-family of antibiotics, which would limit future antibiotic choices.

If your child is on amoxicillin or Augmentin and develops a rash, always consult your pediatrician. If considered appropriate by your pediatrician, you can be evaluated by an allergist to assess if future avoidance is needed.

If you’re interested in finding your nearest Texas Children’s Pediatrics location, click here.

What are antibiotics?

Antibiotics are medicines that treat infections and diseases caused by bacteria. Antibiotics damage bacteria so the body’s immune system can fight them. They do not work against viruses.

Different antibiotics work against different bacteria. Penicillin is an example of an antibiotic. Sometimes, doctors choose an antibiotic based on what they believe will work. At other times, doctors will perform tests to work out which bacteria are causing the infection, and which antibiotics are likely to be effective against them.

Many antibiotics are less effective than they once were due to them being used so often and bacteria becoming resistant to their effects. This is called antibiotic resistance. Antibiotics should only be used if they are needed to treat a bacterial infection.

Allergic reaction to antibiotics

If you are allergic to antibiotics, you may get signs and symptoms like a rash, swelling of the face or difficulty breathing.

Anaphylaxis is a severe allergic reaction, and usually occurs within an hour of taking an antibiotic. A severe allergic reaction is a medical emergency requiring immediate medical attention. You may need to call triple zero (000) and perform first aid.

The symptoms of anaphylaxis are:

• difficult/noisy breathing
• swelling of the tongue
• swelling/tightness of the throat
• difficulty talking/hoarse voice
• wheezing or coughing
• dizziness or collapse
• pale and floppy (especially young children)

Sometimes you can get less dangerous symptoms before an anaphylaxis, such as:

• swelling of the face, lips and/or eyes
• hives or welts
• abdominal pain or vomiting

If you are allergic to antibiotics you may be instructed by a doctor how to avoid triggers and if severe they may instruct you how to use an adrenaline autoinjector such as EpiPen®. The doctor will record the allergy and type of reaction in your notes and electronic health records and will give you an anaphylaxis action plan. You may be advised to wear an emergency ID.

Most allergies are caused by penicillin or antibiotics closely related to penicillin, or by another type of antibiotic called sulfonamides, but any antibiotic could cause an allergy. If you are allergic to one antibiotic in a class, you are likely to be allergic to all other antibiotics in that class.

Feeling nauseous and vomiting after taking antibiotics is a common side-effect of the medicine, rather than an allergic reaction.

Your doctor can usually diagnose allergic reactions to antibiotics by talking to you. They may refer you to an allergy specialist, who may ask for skin allergy and blood tests.

If you have any other concerns about antibiotics, including possible side effects, contact your doctor.

What is antibiotic resistance?

Many bacterial infections are treated with antibiotics. Sometimes the bacteria change to protect themselves against the antibiotic. When this happens the antibiotic no longer works. This is called antibiotic resistance and is a serious global problem.

The more bacteria are exposed to antibiotics, the more chances they have to change and become resistant. If you use antibiotics when they’re not needed or don’t take antibiotics properly — such as missing doses or not completing the course — you give bacteria opportunities to become resistant.

If an antibiotic no longer works against the resistant bacteria:

• infections take longer to heal
• infections can get worse and lead to more serious problems
• infections are more likely to spread to other people. Because bacteria are resistant, the antibiotic may not work for other people, further spreading the problem

Sometimes it is possible to use another antibiotic to which bacteria aren’t resistant. However, it may not work as well, and it could have side effects. Also, bacteria may eventually become resistant to this antibiotic too.

For these reasons, antibiotic resistance is a major threat to human health. There is concern that in time, there’ll be bacterial infections that just can’t be treated.

What are ‘superbugs’?

‘Superbugs’ are bacteria that are difficult to treat because they are resistant to several different antibiotics, and especially those that treat other resistant bacteria.

Superbugs such as Methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug-resistant strains of Escherichia coli (E. coli) are becoming more common, and can be a real problem in hospitals.

How can I help prevent antibiotic resistance?

Antibiotic resistance can’t be totally stopped, but it can be slowed down by sensibly using antibiotics. You can help by:

• not taking antibiotics for a cold or the flu, including cough and sore throat; viruses cause most colds, and antibiotics don’t work against viruses
• telling your doctor you only want antibiotics when necessary — such as for serious bacterial infections like pneumonia
• taking your antibiotic as prescribed, and completing the full course, even if you start to feel better
• never saving antibiotics for the next time you’re sick
• never taking antibiotics prescribed for someone else
• having good hygiene practices to avoid spreading infections

What does an antibiotic allergy look like?

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