title: Selection of treatment of cefaclor-associated urticarial, serum sickness-like reactions and erythema multiforme by emergency pediatricians: lack of a uniform standard of care.
abstract: BACKGROUND
  Serum sickness-like reactions (SSLR) and erythema multiforme are common adverse effects of cefaclor therapy and can be associated with significant morbidity. No standardized evidence-based protocol for the optimal treatment of drug-induced SSLR exists.
  
  
  OBJECTIVE
  To define the standard of care used by physicians treating adverse reactions associated with cefaclor.
  
  
  METHODS
  A retrospective review of the medical records of children discharged from a pediatric emergency room with a diagnosis of adverse events to cefaclor was conducted. Charts of patients were reviewed to determine which therapy was prescribed.
  
  
  RESULTS
  During the study period, 74 cases of adverse events attributed to cefaclor presented to the emergency department. SSLR were the most common pattern of adverse events seen (31 cases, 42%), followed by urticarial reactions (26 cases, 35%) and erythema multiforme (17 cases, 23%). An antihistamine was the treatment most often prescribed (88%) for erythema multiforme. Significantly more children with SSLR than with erythema multiforme or urticaria were treated with prednisone, either alone or in combination (P<0.05).
  
  
  CONCLUSIONS
  The treatment most often prescribed for serious cefaclor-associated erythema multiforme was an antihistamine. In the case of SSLR, an antihistamine and prednisone were most commonly used. Prospective randomized, controlled trials are needed to define the role of various therapeutic agents and to determine the optimal therapy for SSLR and other serious adverse drug reactions.
authors.affiliation: Children's Hospital of Western Ontario, University of Western Ontario, London, Canada.
authors.forename: G I
authors.initials: GI
authors.lastname: Joubert
authors.forename: K
authors.initials: K
authors.lastname: Hadad
authors.forename: D
authors.initials: D
authors.lastname: Matsui
authors.forename: J
authors.initials: J
authors.lastname: Gloor
authors.forename: M J
authors.initials: MJ
authors.lastname: Rieder
mesh_terms: D002433:Cefaclor / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment / Q000592:standards*; D004892:Erythema Multiforme / Q000139:chemically induced / Q000188:drug therapy*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012713:Serum Sickness / Q000139:chemically induced / Q000188:drug therapy*; D014581:Urticaria / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D002511:Cephalosporins; D006634:Histamine H1 Antagonists; D002433:Cefaclor