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• W4229775650 abstract "We herein report a case of intravenous ciprofloxacin desensitization. Although ciprofloxacin allergy was considered uncommon, in the last few years there have been several reports of anaphylactoid reactions, vasculitis, and other hypersensitivity phenomena induced by this medication.1Vidal C Suárez J Martínez M González-Quintela A Ciprofloxacin-induced glottic angioedema [letter].Postgrad Med J. 1995; 71: 318Crossref PubMed Scopus (6) Google Scholar, 2Davis H McGoodwin E Greene Reed T Anaphylactoid reactions reported after treatment with ciprofloxacin.Ann Intern Med. 1989; 111: 1041-1043Crossref PubMed Scopus (82) Google Scholar, 3Assouad M Willcourt RJ Goodman PH Anaphylactoid reactions to ciprofloxacin.Ann Intern Med. 1995; 122: 396-397Crossref PubMed Scopus (18) Google Scholar, 4Soetikno RM Johnson JL Carey JT Ciprofloxacin-induced anaphylactoid reaction in a patient with AIDS [letter].Ann Pharmacother. 1993; 27: 1404PubMed Google Scholar, 5Dávila I Díez ML Quirce S Fraj J De La Hoz B Lazaro M Cross-reactivity between quinolones. Report of three cases.Allergy. 1993; 48: 388-390Crossref PubMed Scopus (60) Google Scholar There seems to be cross-reactivity between the different quinolones, which precludes substitution of one quinolone for another after an allergic reaction to any given quinolone.5Dávila I Díez ML Quirce S Fraj J De La Hoz B Lazaro M Cross-reactivity between quinolones. Report of three cases.Allergy. 1993; 48: 388-390Crossref PubMed Scopus (60) Google Scholar The patient, a 35-year-old woman, who had been diagnosed with chronic granulomatous disease, reported itching and an erythematous rash localized to the arm that had the intravenous line immediately after ciprofloxacin infusion in 1993, during therapy for a Serratia soft-tissue infection at the National Institutes of Health. To verify that the rash was associated with ciprofloxacin, she underwent a ciprofloxacin challenge. The patient was premedicated with hydroxyzine (10 mg by mouth), ranitidine (50 mg intravenously), and albuterol (2 puffs). An infusion of ciprofloxacin (400 mg intravenously in 275 ml of D5W) was initiated. After a few minutes, the patient reported generalized pruritus and headache, and erythema developed over her left arm. Within an hour after the infusion, urticaria developed over her back, upper arms, and left breast. No hypotension or wheezing developed. The ciprofloxacin was discontinued, and the patient was hence instructed to avoid all quinolones. The patient was subsequently admitted to the National Institutes of Health in 1995 for treatment of Burholderia cepacia pneumonia. Her lung disease progressed after a week of therapy with β-lactam antibiotics, to which the organism was susceptible in vitro. The addition of ciprofloxacin was considered necessary, because the organism was highly susceptible to this antibiotic. A review of the literature failed to reveal any report of desensitization to a quinolone. We thus designed a desensitization protocol for cip-rofloxacin based on penicillin desensitization. Given the critical condition of the patient, we elected to premedicate her with diphenhydramine hydrochloride (50 mg intravenously) and prednisone (10 mg intravenously) 1 hour before the desensitization. She was already receiving continuous infusion of ranitidine with her hyperalimentation. After informed consent was obtained, we used three different drug concentrations in a stepwise fashion, as shown in Table I. The individual doses were administered at 15-minute intervals. Because the patient was intubated in the intensive care unit, vital signs were continually monitored. The patient’s skin was inspected for development of urticaria, and her chest was auscultated for wheezing every 10 minutes. No rash, hypotension, or wheezing developed during desensitization. The procedure took 4 hours, and once finished, the patient had received an equivalent to her first scheduled dose (400 mg twice daily). The second dose was given 4 hours later, followed by routine administration of 400 mg every 12 hours, with a small dose (25 mg intravenously) between therapeutic doses, to maintain a drug level in the blood. The patient subsequently received 4 weeks of ciprofloxacin treatment without difficulty. Tabled 1TableI.Desensitization regimen for ciprofloxacinCiprofloxacin concentration (mg/ml)Volume given (ml)Absolute amount (mg)Cumulative total dose (mg)0.10.10.010.010.10.20.020.030.10.40.040.070.10.80.080.1510.160.160.3110.320.320.6310.640.641.2720.61.22.4721.22.44.8722.44.89.67251019.672102039.672204079.6724080159.672120240399.67Drug volumes below 1 ml were mixed with normal saline solution to a final volume of 3 ml and then slowly infused; the other doses were administered over 10 minutes, except the last dose (240 mg in 120 ml), which was given with an infusion pump over 20 minutes. Open table in a new tab Drug volumes below 1 ml were mixed with normal saline solution to a final volume of 3 ml and then slowly infused; the other doses were administered over 10 minutes, except the last dose (240 mg in 120 ml), which was given with an infusion pump over 20 minutes. Reactions to the quinolones are not as uncommon as initially thought. Anaphylactoid reactions were reported at an estimated rate of 1.2 per 100,000 prescriptions in 1989,2Davis H McGoodwin E Greene Reed T Anaphylactoid reactions reported after treatment with ciprofloxacin.Ann Intern Med. 1989; 111: 1041-1043Crossref PubMed Scopus (82) Google Scholar and at least 29 cases have been published.3Assouad M Willcourt RJ Goodman PH Anaphylactoid reactions to ciprofloxacin.Ann Intern Med. 1995; 122: 396-397Crossref PubMed Scopus (18) Google Scholar The reactions vary from life-threatening reactions characterized by severe hypotension, fever, urticaria, and angioedema to erythematous, pruriginous rashes. Patients infected with HIV appear to be especially susceptible to anaphylactoid reactions to ciprofloxacin. It has been noted that patients infected with HIV have reactions after repeated exposure to ciprofloxacin, whereas reactions in patients not infected with HIV tend to appear after initial treatment with this drug.4Soetikno RM Johnson JL Carey JT Ciprofloxacin-induced anaphylactoid reaction in a patient with AIDS [letter].Ann Pharmacother. 1993; 27: 1404PubMed Google Scholar Cases of isolated laryngeal edema requiring intubation have also been reported.1Vidal C Suárez J Martínez M González-Quintela A Ciprofloxacin-induced glottic angioedema [letter].Postgrad Med J. 1995; 71: 318Crossref PubMed Scopus (6) Google Scholar Rash, pruritus, and photosensitivity reactions occur in about 1% of patients receiving a quinolone. Severe skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, are so infrequent as to merit publication. There also have been reports of hypersensitivity vasculitis, Schönlein-Henoch purpura, and serum sickness–like disease during treatment with quinolones. There is, however, a paucity of immunologic data that explain these phenomena. A type I hypersensitivity reaction is suggested by the history of previous exposure in some patients and the reported cross-reactivity between quinolones.5Dávila I Díez ML Quirce S Fraj J De La Hoz B Lazaro M Cross-reactivity between quinolones. Report of three cases.Allergy. 1993; 48: 388-390Crossref PubMed Scopus (60) Google Scholar However, no increase in total IgE level has been demonstrated, and specific IgE has not been detected by RAST. Dávila et al.5Dávila I Díez ML Quirce S Fraj J De La Hoz B Lazaro M Cross-reactivity between quinolones. Report of three cases.Allergy. 1993; 48: 388-390Crossref PubMed Scopus (60) Google Scholar observed positive prick test responses to ciprofloxacin in one of their patients, but also reported positive test results in some control subjects. The possibility of direct mast cell activation, as well as other non-IgE-dependent mechanisms, must be considered. Situations in which a quinolone is the only acceptable therapeutic option are probably uncommon. If that is the case, however, we offer this protocol as a viable option with appropriate supervision." @default.
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• W4229775650 title "Ciprofloxacin desensitization" @default.
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