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Ngo SY, Rabbat JC. Systemic IgE-mediated hypersensitivity reaction to topical polymyxin B. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:734-735. [PMID: 30053590 DOI: 10.1016/j.jaip.2018.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/12/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
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Abstract
BACKGOUND Polymyxin B is not included in most standard contact allergen series. The aim of this study was to determine the prevalence of contact sensitization to polymyxin B in a population of patients referred for patch testing. METHODS A retrospective cohort study design was used to collect data on 795 patients referred to the contact dermatitis clinic of the McGill University Health Centre, as well as to the office of one of the authors (L.M.), between March 2014 and November 2015. Patients were patch tested to the North American Contact Dermatitis Group baseline series and polymyxin B sulfate 3% in petrolatum. RESULTS Out of 795 tested individuals, 18 were allergic to polymyxin B, for a prevalence of 2.3%. The eruptions affected almost all body parts, but mostly the face. The degree of reaction ranged from 1+ to 2+. Isolated reactions to polymyxin B occurred in 9 (50%) patients, whereas reactions to bacitracin and polymyxin B were seen in the other 9. Only 1 patient reacted to bacitracin, polymyxin B, and neomycin (11.1%). Most reactions (12/18) were from past exposure to polymyxin B. CONCLUSIONS Allergic reactions to polymyxin B are not rare, and this antibiotic warrants inclusion in the standard patch testing series.
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Hume-Smith KM, Groth AD, Rishniw M, Walter-Grimm LA, Plunkett SJ, Maggs DJ. Anaphylactic Events Observed within 4 h of Ocular Application of an Antibiotic-Containing Ophthalmic Preparation: 61 Cats (1993–2010). J Feline Med Surg 2017; 13:744-51. [PMID: 21906985 DOI: 10.1016/j.jfms.2011.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 10/17/2022]
Abstract
This study describes signalment, history, antibiotic administered, clinical signs observed, therapy, and outcome of anaphylactic events within 4 h following ophthalmic administration of an antibiotic to cats. Data came from survey responses (45 cats) or Federal Drug Administration reports (16 cats). Cat age (7 weeks—19 years), breed, and gender ranged widely. Most were healthy (87%) prior to anaphylaxis. Ophthalmic antibiotics commonly were administered for conjunctival (65%) or corneal (11%) disease, or ocular lubrication (7%) and contained bacitracin, neomycin, and polymyxin B (44%), or oxytetracycline and polymyxin B (21%). Polymyxin B was present in all cases. Vaccines or other drugs were also administered to 51% of cats. In 56% cases, anaphylaxis occurred within 10 min of drug application. Most (82%) cats survived. Although a causal association was not proved, ophthalmic antibiotic administration preceded anaphylaxis in all cats. Like other drugs, ophthalmic antibiotics should be used only when indicated.
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Affiliation(s)
- Karen M Hume-Smith
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Allyson D Groth
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Mark Rishniw
- Veterinary Information Network, 777 West Covell Blvd, Davis, CA 95616, USA
| | - Linda A Walter-Grimm
- Food and Drug Administration, Center for Veterinary Medicine, Rockville, MD 20855, USA
| | - Signe J Plunkett
- Emergency Animal Clinic, 2260 W Glendale Ave, Phoenix, AZ 85021, USA
| | - David J Maggs
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Novel negative pressure wound therapy with instillation and the management of diabetic foot infections. Curr Opin Infect Dis 2015; 28:151-7. [PMID: 25692273 DOI: 10.1097/qco.0000000000000146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The use of negative pressure wound therapy with instillation (NPWTi) in complex or difficult-to-treat acute and chronic wounds has expanded rapidly since the introduction of commercially available NPWTi systems. We summarize the evidence related to NPWTi and particularly focus on the application of this technology in diabetic foot ulcers, diabetic foot infections and postoperative diabetic wounds. RECENT FINDINGS The benefits of negative pressure wound therapy (NPWT) are well documented in the treatment of complex acute and chronic wounds, including noninfected postoperative diabetic wounds and diabetic foot ulcers. Combining intermittent wound irrigation with NPWT may offer additional benefits compared to NPWT alone, including further reduction of wound bed bioburden, increased granulation tissue formation and provision of wound irrigation in a sealed environment, thus preventing potential cross-contamination events. Recently, available evidence suggests that adjunctive NPWTi may be superior to standard NPWT in the management of diabetic infections following surgical debridement and may promote granulation tissue formation in slow-to-heal wounds. SUMMARY Available evidence relating to the utilization of NPWTi in diabetic foot infections is promising but limited in quality, being derived mostly from case series or small retrospective or prospective studies. In order to confirm or refute the potential benefits of NPWTi in this patient cohort, well designed randomized controlled studies are required that compare NPWTi to NPWT or standard wound care methodologies.
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Bonomo RA, Van Zile PS, Li Q, Shermock KM, McCormick WG, Kohut B. Topical triple-antibiotic ointment as a novel therapeutic choice in wound management and infection prevention: a practical perspective. Expert Rev Anti Infect Ther 2014; 5:773-82. [PMID: 17914912 DOI: 10.1586/14787210.5.5.773] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Triple-antibiotic ointment (TAO) is a safe and effective topical agent for preventing infections in minor skin trauma. The formulation contains neomycin, polymyxin B and bacitracin in a petrolatum base. TAO is active against the most common disease-causing pathogens found in wounds and on the skin and may be an attractive alternative to oral therapy in select circumstances. Resistance to TAO does not develop readily, and safety studies have shown that the risk of allergic sensitivity to TAO is low. Susceptibility profiles of TAO have remained relatively unchanged since its discovery. Prophylaxis or treatment with TAO should be considered as resistant organisms continue to emerge in the community and hospital setting.
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Affiliation(s)
- Robert A Bonomo
- Case Western Reserve University, Veteran Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA.
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Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management. J Am Acad Dermatol 2008; 58:1-21. [PMID: 18158924 DOI: 10.1016/j.jaad.2007.07.050] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 06/12/2007] [Accepted: 07/21/2007] [Indexed: 12/20/2022]
Abstract
UNLABELLED Topical antibiotics are widely used to treat cutaneous, ocular, and otic infections. Allergic contact dermatitis to topical antibiotics is a rare but well-documented side effect, especially in at-risk populations. The purpose of this article is to review the epidemiology, responsible allergens, and management of allergic contact dermatitis to topical antibiotics. LEARNING OBJECTIVE After completing this learning activity, participants should be able to describe the epidemiology of allergic contact dermatitis related to topical antibiotics; show knowledge of the most common allergenic topical antibiotics; and understand the allergenic cross-reactivity pattern amongst topical antibiotics.
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Sachs B, Fischer-Barth W, Erdmann S, Merk HF, Seebeck J. Anaphylaxis and toxic epidermal necrolysis or Stevens-Johnson syndrome after nonmucosal topical drug application: fact or fiction? Allergy 2007; 62:877-83. [PMID: 17620064 DOI: 10.1111/j.1398-9995.2007.01398.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Drug-induced anaphylaxis and toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS) represent severe immediate and delayed-type adverse drug reactions (ADRs), respectively. Occurrence of such reactions after topical drug application has only rarely been reported. Hence, we compiled a large number of such cases which we systematically analyzed. METHODS All such cases contained in the ADR database of the competent pharmacovigilance authority in Germany and cases reported in literature were identified, evaluated and analyzed with regard to potential risk factors. Since the application of drugs to mucous membranes facilitates their entry to the systemic circulation only cases occurring after non-mucosal topical drug application were considered. RESULTS After evaluation 28 anaphylaxis database cases and 48 anaphylaxis literature cases remained for analysis. Application to skin wounds or to skin with impaired barrier function was identified as a risk factor in 10/28 (36%) of the database cases and in 42/48 (88%) of the literature cases. In 9/28 database cases (32%), anaphylaxis was induced by drugs used for their hyperemizing effect and, in 8/28 cases (29%) by antibiotics or antiseptics. In the literature cases, anaphylaxis was induced by antibiotics or antiseptics in 35/48 cases (73%). Only one SJS database case and one TEN literature case remained after case evaluation. CONCLUSION Anaphylaxis does occur after non-mucosal topical drug administration. Application of drugs to skin wounds or to skin with impaired barrier function may pose a risk factor for its occurrence. TEN or SJS following non-mucosal topical drug application seems to be extremely rare.
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Affiliation(s)
- B Sachs
- Division of Pharmacovigilance, Federal Institute for Drugs and Medical Devices, Bonn, Germany
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Abstract
BACKGROUND Antibiotics are often prescribed in perioperative settings, including dermatologic surgery. Given the continued evolution in the breadth and complexity of cutaneous procedures performed and inevitable localized or distant infections that occasionally occur, it seems prudent to periodically evaluate findings and recommendations from the literature regarding the use of antibiotics in cutaneous surgery. MATERIALS AND METHODS Literature review from English-language sources from the past 30 years, especially focusing on sources from the past 5 to 10 years. Data were examined for a variety of cutaneous surgical procedures, routes of antibiotic administration, and consideration of both cutaneous and distant infections. RESULTS The literature suggests that, for most routine skin procedures, antibiotic use is probably not warranted for the prevention of surgical wound infection, endocarditis, and late prosthetic joint infections. During prolonged Mohs procedures, delayed repairs, grafts, takedowns of interpolation flaps, or any procedure that breaches a mucosal surface, the evidence is less clear, and decisions should be made on a case-by-case basis. Topical antibiotics are probably overused, although silver sulfadiazine may have an undeserved negative reputation among dermatologists. Systemic prophylactic antibiotics for laser resurfacing and liposuction appear not to be routinely necessary, although patients with known prior herpes infection likely should receive antiviral prophylaxis. The overall reported infection rates and infectious complications remain low in dermatologic surgery, and antibiotic therapy may be prescribed excessively or inappropriately as a result. CONCLUSION.: Antibiotics continue to be widely used, and through varying routes of administration, in the setting of dermatologic surgery. Prudent use of these agents is indicated in high-risk patients, certain anatomic locations, and the presence of overt infection. Additional studies may help clarify the most appropriate indications, and in which patient populations, in the future.
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Affiliation(s)
- Michael J Messingham
- Department of Dermatolgy, University of Iowa Hospital and Clinics, Iowa City, 52242, USA
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Abstract
BACKGROUND Bacitracin is an antibiotic that is produced by Bacillus subtilis, which is used in several types of consumer products, including cosmetics and ophthalmic and cutaneous ointments. OBJECTIVE To call attention to the rising allergic contact dermatitis associated with bacitracin. RESULTS Mass usage has resulted in an increasing number of clinically relevant allergic contact dermatitis reactions and near fatal anaphylaxis. The North American Contact Dermatitis Group has recorded its emergence as a leading allergen and continues to monitor the ever-growing allergic reaction rates. CONCLUSION The clinical impact, scientific evidence, and need for medical cost containment all advocate the discontinuation of routine usage of bacitracin in clean surgical wounds.
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Affiliation(s)
- Sharon E Jacob
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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From Road Rash to Top Allergen in a Flash. Dermatol Surg 2004. [DOI: 10.1097/00042728-200404000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antevil JL, Muldoon MP, Battaglia M, Green R. Intraoperative anaphylactic shock associated with bacitracin irrigation during revision total knee arthroplasty. A case report. J Bone Joint Surg Am 2003; 85:339-42. [PMID: 12571314 DOI: 10.2106/00004623-200302000-00024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jared L Antevil
- Department of General Surgery, Naval Medical Center, San Diego, CA 92134, USA
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Nordt SP, Cantrell FL, Rodriguez GJ. Anaphylactic reaction to dermal exposure to cephalexin. Am J Emerg Med 1999; 17:492-3. [PMID: 10496518 DOI: 10.1016/s0735-6757(99)90257-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
This report describes a case of systemic anaphylaxis to bacitracin zinc ointment in a 24-year-old man who was injured in a motorcycle accident. Extensive abrasions on the patient's extremities were cleaned with Shurclens before application of viscous Xylocaine and bacitracin zinc ointment. Five minutes later, the patient exhibited symptoms of severe anaphylaxis and required the administration of epinephrine, antihistamines, intravenous fluids, and corticosteroids. Two weeks later, he underwent prick/puncture skin testing to Shurclens and bacitracin zinc ointment as well as prick/puncture, intracutaneous, and subcutaneous challenge with Xylocaine. Only the result of the prick test to bacitracin zinc ointment was positive. Although bacitracin is considered to be a safe topical antibiotic, physicians should be aware of the potential not only for delayed hypersensitivity but also for acute IgE-mediated allergic reactions and life-threatening anaphylaxis.
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Affiliation(s)
- J A Saryan
- Department of Allergy and Immunology, Lahey Hitchcock Medical Center, Burlington, MA 01805, USA
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Lin FL, Woodmansee D, Patterson R. Near-fatal anaphylaxis to topical bacitracin ointment. J Allergy Clin Immunol 1998; 101:136-7. [PMID: 9449517 DOI: 10.1016/s0091-6749(98)70209-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- F L Lin
- Department of Internal Medicine, Naval Medical Center San Diego, CA 92134-5000, USA
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Affiliation(s)
- S R Knowles
- Department of Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
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Peebles RS, Bochner BS. ANAPHYLAXIS IN THE ELDERLY. Immunol Allergy Clin North Am 1993. [DOI: 10.1016/s0889-8561(22)00419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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