title: Incidence of rash after amoxicillin treatment in children with infectious mononucleosis.
abstract: BACKGROUND
  "Ampicillin rash," a phenomenon unique to patients with Epstein-Barr virus acute infectious mononucleosis (AIM) treated with ampicillin, was first reported in the 1960s. The incidence was estimated as being between 80% and 100%, and the figures have not been reviewed since those first accounts. We sought to establish the current incidence of rash associated with antibiotic treatment among children with AIM.
  
  
  METHODS
  A retrospective study of all hospitalized children diagnosed as having AIM based upon positive Epstein-Barr virus serology in 2 pediatric tertiary medical centers in Israel.
  
  
  RESULTS
  Of the 238 children who met the study entry criteria during the study period, 173 were treated with antibiotics. Fifty-seven (32.9%) of the subjects treated with antibiotics had a rash during their illness compared with 15 (23.1%) in untreated patients (P = .156; not significant). Amoxicillin was associated with the highest incidence of antibiotic-induced rash occurrence (29.5%, 95% confidence interval: 18.52-42.57), but significantly lower than the 90% rate reported for ampicillin in past studies. Age, gender, ethnicity, and atopic or allergic history were not associated with the development of rash after antibiotic exposure. Among the laboratory data, only increased white blood cell counts were more prevalent among subjects who did not develop an antibiotic-induced rash.
  
  
  CONCLUSIONS
  The incidence of rash in pediatric patients with AIM after treatment with the current oral aminopenicillin (amoxicillin) is much lower than originally reported.
authors.affiliation: Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Aluma
authors.initials: A
authors.lastname: Chovel-Sella
authors.forename: Amir
authors.initials: A
authors.lastname: Ben Tov
authors.forename: Einat
authors.initials: E
authors.lastname: Lahav
authors.forename: Orna
authors.initials: O
authors.lastname: Mor
authors.forename: Hagit
authors.initials: H
authors.lastname: Rudich
authors.forename: Gideon
authors.initials: G
authors.lastname: Paret
authors.forename: Shimon
authors.initials: S
authors.lastname: Reif
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000658:Amoxicillin / Q000009:adverse effects* / Q000627:therapeutic use; D000704:Analysis of Variance; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D015331:Cohort Studies; D003875:Drug Eruptions / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D005076:Exanthema / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007244:Infectious Mononucleosis / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution
chemical_list: D000658:Amoxicillin
keywords: ampicillin/amoxicillin rash; antibiotic treatment; clinical and laboratory disease characteristics; infectious mononucleosis