Antibiotics and allergies

[Matt8700, RN, EMT-B]

This is probably a really dumb question, but I just wanted some input....

If a patient tells you that they have an allergy to something like Levaquin, and it was a true allergy (not just something like an upset stomach), would you hold any other antibiotics from that same class if they were ordered for the patient?? You can't just assume that it's only Levaquin they will be allergic to, right? You'd have to hold any antibiotics from that whole class, right?

thanks for the help!

[elijahvegas, ASN, RN, EMT-P]

i would suggest to the md to consider switching into a different class of ABX, but if the doc refuses id go ahead and give it and just closely closely closely monitor for any adverse reactions. if i wasn't absolutely slammed i would actually consider spending the first several minutes of the infusion directly next to the patient just to assess/reassess

[NurseOnAMotorcycle, ASN, RN]

That. And I also call pharmacy and double check with them too.

[Rose_Queen, BSN, MSN, RN]

Not ER, but OR, where we routinely give prophylactic antibiotics prior to surgical incision. We have some standard, common knowledge substitutions- if a patient is allergic to penicillin, we don't even give cephalosporins but go to vancomycin- the order sets actually state "Ancef 2g IV on call to OR; Vancomycin 1g IV one hour to incision in cases of penicillin or cephalosporin allergy". Same with any class of drugs- we also use Ciprofloxacin in cardiac surgery in conjunction with Ancef or Vanco, but if someone is allergic to any fluoroquinolone, we switch to another class, such as Zosyn.

[AZQuik]

Pharmacy. We have a couple great PharmD's on through the daytime and into the night. When it's late and they go home we call Central Pharmacy. We have some great ones there as well. This kind of question is their specialty, I let them show off and then document their name in the chart. "OK to admin X per Pharmacy call to Mr. Pharmacist."

Then I explain reasons the other should hit the call light related to allergies. Then I can monitor them for a while. Just a pop your head in, lay eyes on them, ask if they are ok, set up shop outside their door, whatever. Depends on the circumstances of the rest of the night/pt load, Dept/ etc.

As a side note, I can't tell you how many times a resident rolled their eyes at me for holding a pt for a little bit after giving abx. And the,"they had it before and did ok". Lol yeah cuz severe allergies always manifest during the initial exposure.

Also can't tell you how many times the orders were so off, only to be told by a resident they put them in on the wrong pt.

I guess the point is don't be afraid to use resources other than an MD. If something doesn't seem right, follow it up with another discipline.