Document Detail

Anaphylactic shock associated with cefuroxime axetil: structure-activity relationships.
MedLine Citation:
PMID:  17488833     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To present a predictive model of allergenicity based on a structure-activity relationship analysis of beta-lactam antibiotics using appropriate skin testing procedures. CASE SUMMARY: A 39-year-old woman was diagnosed with anaphylactic shock a few minutes after taking a 500 mg tablet cefuroxime of axetil and was admitted to the emergency department with dizziness, facial angioedema, generalized skin rash, and inferior cardiac ischemia. Skin testing confirmed the involvement of cefuroxime as the cause of the anaphylactic reaction, and the reaction was defined as probable according to the Naranjo probability scale. We then performed skin testing to study cross-reactivity between different beta-lactam antibiotics. In addition to this initial assessment, a structure-activity relationship (SAR) analysis was done. It showed that the patient was sensitized to beta-lactam antibiotics presenting a methoxyimino group, but not to similar compounds lacking this chemical group (eg, amoxicillin or penicillin G or V). Challenge with amoxicillin under intensive medical monitoring was tolerated up to a cumulated dose of 1 g, administered intravenously over 2 hours. DISCUSSION: This study demonstrates that SAR analysis could be useful to predict potential adverse reactions to related antibiotics and to select alternative strategies when antibiotic administration is essential. CONCLUSIONS: An SAR-based approach could help physicians and pharmacists provide allergic patients with relevant advice and propose viable alternatives regarding drug therapy.
Frédéric Hasdenteufel; Samuel Luyasu; Jean-Marie Renaudin; Philippe Trechot; Gisèle Kanny
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-05-08
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  41     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-25     Completed Date:  2007-06-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1069-72     Citation Subset:  IM    
EA 3999 maladies allergiques: diagnostic et thérapeutique, Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital of Nancy, Nancy, France.
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MeSH Terms
Anaphylaxis / chemically induced*
Anti-Bacterial Agents / adverse effects*
Cefuroxime / adverse effects,  analogs & derivatives*,  chemistry
Cross Reactions
Skin Tests
Structure-Activity Relationship
Reg. No./Substance:
0/Anti-Bacterial Agents; 55268-75-2/Cefuroxime; 64544-07-6/cefuroxime axetil

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