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Re: Are there any Pharmacists here? I would like to ask a question, please!

[ Edited ]

@Tribefan wrote:

My younger son has also weighed in on the issue. He specializes in infectious diseases.

His response follows:

 

It’s very important to know exactly which antibiotic you reacted to. MicroBID is the brand name for an antibiotic called nitrofurantoin - it is pretty much exclusively used for the treatment of urinary tract infections (UTIs) and doesn’t have much utility for anything else. Macrolides, however, are a class of related antibiotics with a variety of different uses. The most commonly used members of this class are erythromycin, clarithromycin, and azithromycin. Azithromycin is probably used most frequently for upper respiratory tract infections and may be referred to as a “Z-pack.” We don’t tend to use erythromycin or clarithromycin much anymore - mostly for acne, tuberculosis, and sometimes skin infections or respiratory tract infections if the patient has an allergy to preferred antibiotics (most commonly, penicillin allergy)

MacroBID is not structurally related to macrolides in any way, and I would not expect any degree of cross-reactivity. If someone reacts to both medications, this could be by chance or their immune system is hypersensitive to many foreign substances introduced to the body. For this reason, it is important to know which drug you reacted to. Details of the reaction are important in distinguishing between life-threatening truly immune mediated reactions compared to mild rashes and even intolerances. Doctors often do not ask any questions further than “what are you allergic to?” because they are typically not equipped to determine the severity and likelihood of having another similar reaction to a related drug (unless of course, it is an allergist).

It sounds like this rash was unpleasant and of course, you would not want to experience it again. My advice would be:
1. Try to figure out exactly what antibiotic you reacted to. Call your pharmacy, they should have record of what you have picked up there. If you were taking it for a UTI, chances are it was MacroBID (nitrofurantoin) which isn’t really similar to any other antibiotics out there, and wouldn’t expect to cross-react.

2. Details of the reaction!
- Was the rash itchy? What did it look like (maculopapular vs. hives - you can google these for images)? - These questions will help determine severity of the reaction and if a re-challenge can be considered. Hives are more likely to occur again, and can be more severe the second time. A maculopapular or “drug rash” may not happen again, or would be of similar or less severity.
- Did you have any shortness of breath or swelling of the face/throat? (this would indicate a serious reaction and you would want to avoid all members of that antibiotic class)
- How long after you took the first dose did this occur? If it happened after the first or second dose, this is indicative of a true allergic reaction. I would not give the exact drug again if this is the case. If, however, you were taking the antibiotic for a week or so, then developed a rash, this would mean it is what we call a "Type 4 reaction". THESE TYPES OF REACTIONS WILL NEVER MANIFEST AS ANAPHYLAXIS if re-challenged. There really isn’t much we know about cross-reactivity with late-onset reactions, but it is expected to be lower risk. You are probably only allergic to that particular drug and other members of the class can be used. Then again, we don’t know much about type 4 reaction except that they will not be life-threatening.

Hope this helps




I am also a pharmacist and the info provided by @Tribefan 's sons is most excellent advice.  I would just like to elaborate a little on what was referred to as a true 'allergy' vs 'intolerance'.  It is an important difference.  If you have hives, rash, anaphylaxis THAT is an allergy which is mediated by the immune system.  If a drug gives you a stomach ache for example, that IS NOT AN ALLERGY. Even if it is a really bad stomach ache. it is not a good idea to have in your medical records that you are allergic to a drug when in fact, you are not allergic to it but maybe just have side effects from it.  It is understandable that you might not want to take that drug as an outpatient again, if you can take something else instead that doesn't give you such side effects.  But what if you are ever really sick, in a hospital, not able to communicate very well and the one antibiotic that has the best chance of saving your life is considered off the table by the treating clinicians, because it is listed in your chart as 'allergic' when in fact it just gives you a stomach ache.  

As mentioned above, a lot of times, physicians and nurses will just ask what you are allergic to and you tell them and they do not ask any further what reaction or symptom you have and note it in your chart. 

 

Edited to clarify, I know the OP was talking about a rash and not a stomach ache in her OP, but I think the difference of immune mediated allergy vs intolerance is important and not enough people, even other health care professionals take the time to distinguish so it is my public sercie announcement Smiley Wink

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Re: Are there any Pharmacists here? I would like to ask a question, please!

This topic is very timely for me, as I have an intolerance to both erythromycin and azithromycin.  

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Re: Are there any Pharmacists here? I would like to ask a question, please!

@Tribefan

 

That is what what has been assumed from the point I was told about 5 years ago that I was allergic to marcrobid  or macrolides.  I was trying to go through some old records of mine and found a note that said "macrolides."  I was not being treated for a urinary, but a  sinus/lung thing.  And I could not find the particular drug I was given.  I had gotten this from one of this quick clinics and they are no longer already.  I have attempted to get a record but cannot.  So, I am going to go with the assumption that all macrolides are off the chart for me.  You have been very helpful and I sincerely appreciate it!!!!  

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

@mememe

 

Yes, I know.  It makes things a lot more difficult and scary when you need an antibiotic and limits your options.  With me, I broke out in a horrible, itchy rash.  I was told that since I exhibited this rash, the next time, I could have an even worse reaction.  So, these drugs should be avoided.  My reaction was not just that I had an upset stomach.  A lot of these meds will mess with your stomach but that is somewhat normal and not a reason to totally abstain from the med.  Thanks so much for your response!  

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

@LTT1

 

Even at that, I am sruck by the lack of comprehension by some doctors and their personnel.  They just give you this blank look.  I mean, --- hello?  Do they not get it that a person could die if given a wrong med?  I am fearful every time one of them says -- well, you need an antibiotic.  Then, I go home and try to check and double check on line looking for facts.  I was actually in the emergency of a hospital for something a while back and was told to take a med.  I specifically asked the doctor,  is this from the type of antibiotics that I cannot take -- I asked him 2ce, in fact.  He said, no, this is fine to take.  I  took his word and got the med filled.  Then, something told me to check further and when I did --- it was one of the forbidden ones for me!!!  I called back and was told that I had not told them I could not take the drug!  One must police their health care constantly --- check, check and double check.  It is very scary.

Thanks for checking in.  It is good to have your input!!!  

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

@lolakimono

 

That's terrible!  I am of the opinon that if they say -- it's doutbtful you will have a reaction, or unlikely, or proabably not --- that is not good enough for me.  I feel that they know a drug is iffy for me given that I have these restrictions so why risk it?  I don't want it.  Give me something else!!!!  But it is not them that is going to have to go through it, so what do they care?  Thanks, lola!  We have to be our own police.  

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

@Tribefan

 

Thank-you, thank-you, thank-you!!!  How wonderful of you to take the time to get all of this information for me!  And for others here who may be experiencing similar problems.

 

I have narrowed it down - I did not receive macrobid.  I received a macrolide.  I experienced this over 6 years ago at the start so it's been difficult to track down.  I was being treated for a severe sinus infection and supposed pleurisy (though I don't know if they were sure about this).  My recollection is somehwat vague.  I had gone to one of those walk-in clinics and it is no longer open, so I could not contact them.  I did find, however, a written note that I had saved from them which said --- "reaction to macrolides -- do not take."  I believe what I had taken was a z-pack although this is not 100%.  My reaction was all over my torso, back and legs and did not begin until I had taken the med for almost 5 or 6 days if my memory serves me.  It was severely itchy, hot and was like a hive type thing if I remember correctly.  I had no problems breathing.

 

Bless you to givine me this valuable information.   

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

@tantallum99

 

Thank you so much for replying and adding on to this.  I agree with what you are saying. I have in fact had a very serious illness in the past and still experience it, although at the present I am not taking meds for it.  The meds for this disease were best treated I was told by taking various macrolides.  However, because of my problem, other antibiotics had to be used.  So, yes, it is very, very important to get facts correct and note whether you simply get an upset stomach or you are, in deed, allergic to a med.  

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

I want to give my thanks and appreciation for everyone here who has been so kind and taken of your time to give me help and assistance!!!  You have no idea how much this has cleared this up for me and eased my mind.  I was getting no where -- fast.  It is just mind boggling how doctors and personnel can truly cause so many problems or just not be giving you good advice or be in good communication with you.  Please do not take this post to be a criiticism of all doctors and personnel, as there are many good and wonderful and caring ones.  But, I have just been not experiencing much in that way lately.  Some times all a person really wants or needs is just a few moments of their time to explain a few things.  Thanks, again, truly, for your help!!!  

"A day without sunshine is like, you know, night." - Steve Martin
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Re: Are there any Pharmacists here? I would like to ask a question, please!

[ Edited ]

Make sure you get that cleared up with your doctors. My dad is allergic to Penicillin. He was in Air Force & a medic gave him a shot of it. My dad started having a reaction & the medic started yelling for help. My dad said he was up above his body watching everyone work on him. They did pronounce him dead. My dad was like no I'm not dead. One doctor said if you are still with us do something move your fingers, your eye something. Dad said he could not move. Finally they saw one of his eyes twitch & they kept working on him. He's still here today but it could have turned out totally different.