Penicillin desentiziation

SmilingBluEyes · Jul 15, 2005

We have never done this. We just use alternative ABX. Frankly, I must be behind the times. I have never, ever heard of such a thing.

Peaches N L&D · Jul 15, 2005

We have never done this. We just use alternative ABX. Frankly, I must be behind the times. I have never, ever heard of such a thing.

Like what? , because I thought Syphillis was treated with PCN or Tetracycline and tetracycline is not recommended during pregnancy.

SmilingBluEyes · Jul 15, 2005

wow well that is a good question. I guess I have not run into this in labor/delivery. I can see more clearly what you are asking. And you are right; there really is no true alternative. I have never had to 'desensitize" a patient to PCN before. GOOD QUESTION---anyone have an answser?

SmilingBluEyes · Jul 15, 2005

I think this is something that should be discussed and worked out with a multi-disciplinary approach, mainly involving the Obstetricians/doctors, anesthesia personnel, pharmacy and nursing at the very least------ it is not some thing YOU alone should address. Ask your pharmacists/doctors for some guidance and advice on this one----and request this be addressed at the OB committee meeting ASAP.

I am sorry I could not help you more----you certainly brought up a really legitimate concern and it deserves a much more proactive approach than your manager has obviously taken. You are quite right to be very concerned, and you have gotten me really thinking! :) I just wish I had answers that help you.

Jolie, BSN · Jul 15, 2005

I thought the reason tetracycline was not recommended during pregnancy was because of possible staining of the infant's teeth once they emerge. That certainly seems like a far less serious issue than risking an anaphylactic reaction in a pregnant woman.

My hubby is allergic to PCN. (He broke out in hives and was seen by his family practice doc who made the diagnosis and told him never to take PCN again.) My youngest daughter likewise broke out in hives during a course of Augmentin. She was also seen in the doctor's office, and her ped recommended giving her a "test" dose in the office the next time she needs an antibiotic. I thought that was the most ridiculous thing I had ever heard, and told him so. Why risk a serious reaction in an office setting when there are so many alternatives available?

I'm also curious to hear what other OBs do with PCN allergic moms. There's got to be a better alternative!

sgent · Jul 15, 2005

Umm... desentization isn't something to take lightly -- it can be very serious. I would get one of your allergists on staff to order it, set up the protocol, and be responsible for it. AKA -- get a consult.

I don't know that much about it, but desentization for previous insect anaphalyxis can take a year or more, however, I think rapid desenitization exists for penicillin that can do it in a day or so. It might can be accellerated, but this needs to be seen by an MD allergist who can do it.

That being said, many doctors will perform an allergy skin test, to see if the patient is truley allergic or had a poor side effect profile. Anesthesiologists do this occassionaly for patients with novacaine allergies. But if they are truley allergic, the desentization is a medical procedure that most physicians won't touch with a 10 foot pole.

From the CDC (endorsed by ACOG amonst others):

Sexually Transmitted Diseases Treatment Guidelines 2002

...

Parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy. Pregnant women with syphilis in any stage who report penicillin allergy should be desensitized and treated with penicillin. Skin testing for penicillin allergy may be useful in pregnant women; such testing also is useful in other patients

...

Patients who have a positive skin test to one of the penicillin determinants can be desensitized ( Table 1 ). This is a straight-forward, relatively safe procedure that can be done orally or IV. Although the two approaches have not been compared, oral desensitization is regarded as safer to use and easier to perform. Patients should be desensitized in a hospital setting because serious IgE-mediated allergic reactions rarely can occur. Desensitization usually can be completed in approximately 4 hours, after which the first dose of penicillin is administered. After desensitization, patients must be maintained on penicillin continuously for the duration of the course of therapy.

.....

There is a table in the report if you OB wants to try to do this...

bagladyrn, RN · Jul 15, 2005

This would really scare me - what about those with a really severe sensitivity to penicillin? I have a history of a true anaphylactic reaction - full arrest - and have had a reaction of hives from simply splashing penicillin solution on my arm while spiking a piggyback. My physician told me never to allow a "scratch test" as that could be enough to set off another anaphylactic reaction. I'd be really worried I'd end up with a pt. like "me"!

BENNETTRN · Jul 15, 2005

Does anyone out there have a protocol for Penicillin desentiziation?, We hardly ever do it, but occasionally there are pregnant women with syphillis who need PCN and are so called allergic to it. We usually call pharmacy and get their protocol and use it (which is all about dosage strength) , but what about the specifics for our maternity unit?, what if she has an anaphylactic reaction? our patients are not admitted (they are out patients), no labs, what if they code?(we do it in our recovery room where the crash cart is near), But I just feel unsafe doing PCN desentiziation, and when I voiced this to my director she said why don't you make a protocol? How rude!!!!! :angryfire

Be very scared, I have never heard of doing this and cant believe that the possiblity of a anaphylactic reaction is taken so lightly there. We had a all out anaphylactic reaction on our unit back in Feburary this year. Mom was

GBS+ and the nurse hung the first dose of Amp., and all you know what broke loose, (this lady came in with NKDA), it took all of us on the unit, approx 10 nurses, anesth x2, the OB, and our manager to run this emergency. She swelled up so fast and the redness quickly crept down her body like a wave, anesth could barely get a airway d/t the severe edema, and heart tones went down like a cliff dive. Mom was in ICU after, and baby in NICU. Maybe you can start talking to some of the nurses in a effort to band together and get this practice changed, or at least a protocol. Good Luck to you, and I hope you dont have to deal with a anaphylactic reaction ever!

sgent · Jul 15, 2005

In that article above, there is a protocol listed, but its meant for physicans.

Unless you've got a cowboy of an OB, I imagine he'd admit the pt and ask for Allergy consult.

rjflyn, ASN, RN · Jul 15, 2005

I worked in PICU and had to desense a couple kids to antibiotics. It literally takes almost 36 hrs before you work up to a actual treatment dose. It is a pain in the you know what. Imagine doing that with 2 antibiotics- we had to. The doses start down in the 1/100,000 of a mcg and work up like every 30mins or so if I recall. I think we also gave Benadryl and Solumedrol as well. I had to be done in these instances because they were literally allergic to almost everything ie PCN, Vanco, Cephlasorins, ect. We did it as the only meds they were not allergic to were allready being given or the bug was resistant.

The allergy specialists there wanted the pts in the ICU, PICU or the like.

RJ

suzanne4, RN · Jul 15, 2005

I have been working in Healthcare for way too many years to count, and would not even consider it as a thought. There are other ways of treating this type of infection................without endangering the lives of two.

There is absolutely no guarantee that this desensitation would work, and anaphylasis is not something that I care to see too often. Once you have had a patient with it, you would never want to take a chance of it occurring again.