Penicillin desentiziation

[Peaches N L&D]

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

[sgent]

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.

Suzanne,

PCN is the only treatment that has evidence behind it to treat a pregnant women/child with syphilis. Desensitization is dangerous, but so is untreated syphilis. I would be hesitant to do it w/o allergist involvement, but like many other medical treatments it has risks and benefits. The evidence shows that its best to do this in pregnant women.

[grannynurse FNP student]

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.

Have to agree with you. I suffered an anaphylatic episode, as a result of exposure to penicillin. There is no way, as a nurse, that I would ever agree to desensitize a patient, let alone tow. The risk are just too great.

Grannynurse :balloons:

[SmilingBluEyes]

So Granny, as a nurse practioner, what would you do? I am curious. I really am at a loss here. Is it worth trying to desensitize, or risk teeth discoloration from using Doxycycline or Tetracycline? I really am ignorant here.

[suzanne4, RN]

I have seen too many cases of anaphylactic shock from someone with an adverse reaction to an antibiotic given in a physician's office, and them arrving in the ER in a code situation. There is absolutely no way that I would electively attempt to desensitize a patient on a general ward, without a full team of intensivists available, etc. The allergists are of no use when the patient needs to be intubated.

And for the OB/Gyn that wants to order it.....................??????

[SmilingBluEyes]

I know, it is crazy, huh, Suzanne? Someone referred to "cowboy" obstetrics. I think that is accurate in this case. And the complacent attitude of the nurse manager is no less frightening. I commend Peaches for her vigilance and desire to take the safest course and her attempt to proceed with the right actions for her patients. Way to advocate! :)

[suzanne4, RN]

I am sure that this is being done but I would only want to see it done in a mjor medical center with full back-up, in an Intensive Care Unit and not on a regular hospital unit. But the problem occurs, when someone wants to try it because they read it somewhere and they do not have the resuscitative training, etc. behind them. And then you have two patients that you are trying to keep alive.

Best suggestion would be to get infectious disease physician involved, so not rely solelyy with what the allergist says. The ID docs spend much more time in crtical care areas, etc.

[suzanne4, RN]

Also, given what I have seen over the years, and knowing what is available now, I would much rather go the Tetracycline route and bleach the teeth later, rather than having a possible anaphylactic reaction and losing both mother and fetus.

[Peaches N L&D]

i know, it is crazy, huh, suzanne? someone referred to "cowboy" obstetrics. i think that is accurate in this case. and the complacent attitude of the nurse manager is no less frightening. i commend peaches for her vigilance and desire to take the safest course and her attempt to proceed with the right actions for her patients. way to advocate! :)

thanks smilingblueeyes.....i spoke to my nm today about it , because we are revising protocols, she mentioned the newly appointed chief of staff would like to look at all of our protocols and up date them. i think involving different specialties like allergist, infection control, intensevists, ect... and the ob's is a great idea and i will mention this to the cheif of ob myself.

thanks everyone for your input! :)

[sgent]

The problem with tetracyclince isn't the teeth, its that it is not known to work in pregnanent women, it may cure the mother but not the child, or may not cure either, but rather cuase it to go into remission and be undetectible for a few years.

This disease is one of the most insideous, destructive, diseases known. In many ways it makes HIV look mild. We haven't had to deal with it since the 50's because of the miracle of PN, but this disease is one of the great scourages and victory's of modern medicine.

I would rather not take the chance of the child getting it, for doing a process that although somewhat dangerous and a pain in the orifice, has very few reported deaths or long term side effects, and is relatively safe if done in the right environment with the right doctors.

[suzanne4, RN]

You nailed it on the head when you said done in the right environment with the right doctors and staff available, but unfortunately, how often is that going to happen? That is what I am worried about.

I have participated in one too many codes on very pregnant women in my day and it is not a pretty picture. I would do absolutely anything than have to be in that place again...........and especially if it is an elective procedure.

[grannynurse FNP student]

So Granny, as a nurse practioner, what would you do? I am curious. I really am at a loss here. Is it worth trying to desensitize, or risk teeth discoloration from using Doxycycline or Tetracycline? I really am ignorant here.

First, I am not yet an NP. Made an error when I posted my screenname.

Second, as one who is extremely, even life threatening reactions, I would not desensitize a patient who had the reaction I have had. As for a pregnant mother, I would leave the decision up to a medical professional who has an excellent track record, in such cases. And I would not undertake the risks, even when a physician has order it, patient has signed a release and the facility says to go a head. To me, if a patient is that allergic, that death can occur, the patient is too sensitive to be desensitized.

As for the discoloration. It is up to the patient. If her teeth are that important to her, i doubt her baby is of equal importance.

Grannynurse :balloons:

[sirI, MSN, APRN, NP]

So Granny, as a nurse practioner, what would you do? I am curious. I really am at a loss here. Is it worth trying to desensitize, or risk teeth discoloration from using Doxycycline or Tetracycline? I really am ignorant here.

I am an OB-GYN NP and I have never desensitized any woman unless she was in the ICU with the proper staff, equipment, etc. This is a very fractious issue and deserves the utmost respect from our OB physicians. It can be a most frightening scene in the absence of pregnancy. Although it is true, "cowboy" OB IS practiced, it is this attitude that will lose the mother and/or baby if densensitization is not properly managed.