To be still giving DS his antibiotic? Any drs out there?

[QueenNefertitty]

DS is 15mo and has been very unwell, for months now, with various infections both viral and bacterial. This culminated last week in a(nother) horrific dash to a&e after he developed a rash that looked a lot like meningitis and didn't blanch. Turns out he has a type of coxsackie virus and bacterial tonsillitis, for the third time in under three months.

Dr started him on coamoxiclav on Friday night (we've already done Pen V twice) and let us come home o Saturday morning. Sunday night he started with diarrhoea- two very loose stools in two hours. Today he's had approx 6 or 7 explosive watery stools.

He's still passing urine and full of energy. Should I stop the co-amoxiclav, or should I take him to the GP tomorrow? Or is this just normal for a baby who is eating few solids, lots of breastfeeding, and taking this antibiotic?

Any advice greatly appreciated.

"he's developed four or five hives around his face... He had one or two yesterday which came and went within an hour - which I called the GP about and was told it was unlikely to be an allergic reaction 6 days into the course..."

Fucking hell, this sort of ignorance makes me Your GP is talking rubbish. That is exactly how my allergic reaction to antibiotics presented - 1 week into a 2-week course of a new-generation super duper antibiotic.

I stopped ABs right away, had antihistamine shot that very night, and was on antihistamine tablets day and night for 5 days but hives were still flaring all over my body. I ended up hospitalised, with IV antihistamines for 48 hours, which finally stopped the allergic reaction. It took one whole week in total for the hives to disappear after I had stopped ABs.

Stop ABs right away and take him straight to A&E tomorrow morning.

Re diarrhoea - It is not unusual for ABs to cause diarrhoea, because they kill good bacteria in the gut as well as the harmful bacteria elsewhere in the body.

Your GP should have prescribed probiotics.

Your GP is talking rubbish.

No they're not. It IS unlikely. It's incredibly rare to have a delayed onset IgE-mediated drug reaction. The commonest cause of urticaria in children is a viral infection. Given the OP's child's symptoms it's by far and away the likeliest cause.

It might be statistically unlikely but allergic reactions DO happen 6 days into a course of antibiotics, presenting with hives - it happened to me, exactly as I described.

You would continue administering antibiotics to a baby who develops hives 6 days into taking them?

The antibiotics are clearly unnecessary anyway, they should never have been started. And the fact that it's statistically unlikely means the GP's advice was completely correct.

I would tell them to stop taking them as it's an indication the child has a virus, rather than because it's a drug reaction.

notbad is right. Most so-called ‘bacterial’ tonsillitis in Pre schoolers is viral but there’s often no throat swab and it’s a myth that there’s an easy clinical differentiator between the two - pus, swelling, fever occur with both bacterial and viral causes because inflammation occurs with both.

In studies of adults definite IgE testing shows that only up to a 1/3 of suspected antibiotic allergy is true allergy and it’s less in children.

From a paper in Current Allergy and Clinical immunology - “suspicions of antibiotic allergy are very common in children, but true allergic reactions are rare and clearly overdiagnosed representing a major public health problem. Indeed, viral skin rashes are falsely labelled as penicillin allergy...”

pdfs.semanticscholar.org/b3df/68ac2815e830ce6a98295f9495d188cab31a.pdf

And yes, the OP’s child’s antibiotic is a penicillin derivative. The diarrhoea is a common side effect of the clavilanic acid.

*clavulanic acid

“GP's advice was completely correct. ”

GP didn’t tell OP to stop antibiotics, though. Therefore his advice was NOT correct.

But your assertion that the GP's advice was wrong due to your anecdote about your experience is incorrect. The GP should have told the OP to stop the antibiotics because they're a waste of time, not because of possible allergy. Besides, we don't actually know what the GP advised about ongoing treatment, it's not clear from the OP's update.

To be honest I'd be sceptical that your reaction was antibiotic-related. Urticaria alone doesn't make any sense in terms of the types of hypersensitivity reactions:

academic.oup.com/cid/article/58/8/1140/355853

Whereas the causes of urticaria are extensive:

en.m.wikipedia.org/wiki/Hives

So I don't think you should get all about GPs when you've likely inferred the wrong conclusion from your own unique personal experience.

Hi all

I hadn't seen the thread for a couple of days... so just to update you....

DS hives indeed got worse over several doses, so I took him back to a (different) GP who actually saw hives flare up on his face, and quickly disappear while we were there. She advised he stop the antibiotic immediately, given his tonsils and throat were no longer displaying ulcers or pus, and administered a dose of antihistamine, with a strong word to call an ambulance should he show any more worrying signs of allergy.

The hives haven't reappeared since we stopped the co-amox.

I've also made an appointment with a private ENT for this week - DS is snoring a lot, and has done since this cycle of tonsillitis started three months ago. He hasn't been well for more than 3 days together since early September, and it's always always his throat/tonsils that get the worst of it.

Good to hear that your DS is better, OP.

"Besides, we don't actually know what the GP advised about ongoing treatment, it's not clear from the OP's update."

It's quite clear to me. OP called the GP about baby's hives. GP said allergic reaction is unlikely so didn't advise stopping the antibiotics.

You can see in OP's latest update that the new GP has stopped the antibiotics and advised calling the ambulance if her baby shows any more sign of allergies.

"To be honest I'd be sceptical that your reaction was antibiotic-related."

And you would be wrong. It was conclusively diagnosed as antibiotic allergy at the time. I was told to remember the name of the family of antibiotics that included the one I reacted to, and to mention it every time I am asked about allergies by medical professionals.

For the nappy rash you need to do a mix of metanium (yellow one) Vaseline and orabase (barrier cream you can buy in the pharmacy) , this was recommended to us by a paediatric doctor when our baby had horrendous nappy rash due to antibiotics and it really is amazing . Will be well cleared up in 24 hours. Wish you all the best for getting the rest of him better too

it was conclusively diagnosed as antibiotic allergy at the time

How? They can’t skin prick test for the IgE response unless you’ve no antihistamine in your blood stream, so that mode of definitive testing can’t have been done at the time.

‘The doctor said it was’ is only right up to a 1/3 of the time in adults. Which means it’s often right but certainly not definitive.

This was over 20 years ago, so I don't recall which tests were done but the doctor who managed my care when I was hospitalised was convinced that the evolution of symptoms I showed (and those I didn't) conclusively pointed to antibiotic allergy.

Most of the time doctors are wrong about antibiotic allergy, so without IgE testing to the specific antibiotic (which wouldn't have been down 20 years ago) you're just dealing with levels of likelihood

Take the OP's child (sorry OP). There may well be caution about prescribing co-amox thereafter which will lead to a wider caution about penicillin allergy even though ;

• delayed antibiotic allergy is very rare in children
• the OP's child had penicillin multiple times in the past without mishap, and the recent antibiotic prescribed was amoxil plus clavulanic acid with the amoxil being a penicillin family drug
• the OP's child was diagnosed with bacterial tonsillitis in the context of known coxsackie virus and VIRUSES are the most common cause of urticarial rashes in children. (Viruses are almost always the cause of pre school tonsillitis as well, with pus, fever and swelling also occurring in viral tonsillitis. You can't tell without a throat swab and the addition of clavulanic acid is unnecessary if the swab grows strep A).
• the urticaria resolved after the antibiotic stopped but also after a antihistamine medication which would be effective in viral-induced urticaria as well.

It would be a shame for the OP's child to have to avoid penicillin based drugs for life based on a mild urticarial reaction to a virus which responded to an anti-histamine. With antibiotic usage as a confounder. Especially as the community alternatives to penicillin are often harder on the GI system.

Pursuing skin testing through an allergy clinic could be useful for clarification; in children, as per my link upthread, almost all supposed antibiotic allergies, diagnosed by doctors, on the basis of skin rashes aren't allergies.

Hello again

So today DS became increasingly unwell again, and crashed to sleep about 6, snoring heavily (presumed tonsils on the swell again)... Woke about 10 tonight with his face swollen with hives, severe stridor and a weird sound in his voice.

Back at A&E, waiting to find out if this is an allergy, return of tonsillitis, or now, a brand new case of croup.

Feel about ready to weep, quite frankly.

You poor thing, and poor DS. I hope it's not another serious one.

How long are you likely to wait? Sending swiftness vibes.

@Altkat

Thank you....

I'm not sure. Weve at least been given a private room, so DS can sleep,and I can lie down to worry. The room was a propos of the fact that I was breastfeeding in the main waiting area. I was more than happy (for once!) to be ushered away...

Poor old DS though. I feel so rotten for him, and keep wondering what on Earth I could do differently to make/keep him well...

Poor boy and poor you op, I hope you've had some answers or at least reassurance and can manage a bit of rest alongside him for the rest of the night

Oh you poor thing. I hope you soon get sorted and he feels better really soon

So we've been given a dose of steroids for the croup... and possibly another antibiotic in case there's still a bacterial infection in the mix- likely erythromycin given his reaction to coamoxiclav

I hate that this will be his 4th course of antibiotics in 3 months. I hate it.

Was your child healthy before September? Are there immune system issues ? Does the onset of issues coincide with any jabs? With regards to co-amox, i had it for a skin infection and it caused me to have severe (uncontrollable) looses stools containing blood, so I stopped it after 3 days.

@tinkywinky

Before September, DS had had two viral infections, one at 10 days, one at 6 months, that saw him in hospital with v high fevers that I couldn't control at home. He's never tolerated vaccinations well, but he's not had any reactions beyond the realms of normal.

Since his first bout of tonsillitis in September, he's never been properly well. I'm worried that there's potentially an underlying issue- and my mind races from leukaemia to coeliac to god knows what, and back again.

And then I think- could it just be normal for a new starter at nursery?

We're now starting erythromycin. I just feel beyond despairing of it all.

Commiserations, OP. A persistently unwell infant is a worry. The steroids will work like magic, as you'll probably already be finding, and the slew of antibiotics will do him no long-term harm. It certainly is plausible that starting at nursery is just having an irritable effect on his immune system, though once this crisis is over it would probably be a good idea to have some further investigations (a) if he has a history of vaccination reaction and (b) to get to the bottom of whether or not there's a drug allergy. It sounds as though you're getting good care. Try not to worry about the endless possibilities. I vividly remember some very scary A&E admissions with one of mine, who is now a strapping lad of whom I am endlessly proud.