Adverse skin and joint reactions associated with oral antibiotics in children: the role of cefaclor in serum sickness-like reactions.
OBJECTIVE
To review presentations to Princess Margaret Hospital Emergency Department (PMH ED) with adverse joint and skin reactions associated with the use of oral antibiotics, to describe the clinical course of children with cefaclor-related serum sickness-like reactions (cefaclor SSLR) and compare these with cases reported to the Adverse Drug Reactions Advisory Committee (ADRAC).


METHODS
Twelve-month retrospective review of presentations to a tertiary paediatric ED (42,000 visits annually) via an ED computer database search and review of medical charts of children presenting with joint or skin reactions. Telephone interviews were conducted with the caregivers of children with cefaclor SSLR.


RESULTS
Adverse skin or joint reactions occurred in 150 children; 70 after cefaclor alone, 10 after cefaclor in combination with other antibiotics and 70 after other antibiotic courses. SSLR occurred in 44 children; 32 after cefaclor alone, five after cefaclor in combination with other antibiotics and seven after other single antibiotics. In children with cefaclor SSLR, otitis media was the most common indication (59.4%), another 18.8% had viral illnesses. Prolonged sequelae occurred in four children, a situation not previously reported. Sixty reports of paediatric cefaclor SSLR were made to ADRAC during the study period, none originated from PMH ED.


CONCLUSIONS
Cefaclor was associated with 53.3% of oral antibiotic related skin and joint adverse reactions and 84.1% of SSLR. The indications for its use in paediatric illness require careful reconsideration. ADRAC data under-represents the incidence of cefaclor SSLR.
King
B A
BA
Emergency Department, Princess Margaret Hospital for Children and School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia. barbara.king@health.wa.gov.au
Geelhoed
G C
GC
D000284:Administration, Oral; D000293:Adolescent; D016907:Adverse Drug Reaction Reporting Systems; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002433:Cefaclor / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003875:Drug Eruptions / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012713:Serum Sickness / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D012720:Severity of Illness Index; D017678:Sex Distribution; D014904:Western Australia / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D002433:Cefaclor