A 4 year old male is brought to the emergency room with a recent onset of a rash, uicaria, and a fever of 101 degrees F. The mother also states that her son has been complaining that his "bones hu." Physical examination reveals mild lymphadenopathy. The patient's past medical history is unremarkable except that he just finished a 10-day course of cefaclor suspension for treatment of an upper respiratory infection. The patient should be treated with ?
Serum sickness is a condition commonly caused by hypersensitivity to drugs. It is suggested that the drug acts as a hapten, which binds to plasma proteins. This drug-protein complex is recognized as being foreign to the body and induces the serum sickness. Common signs and symptoms of serum sickness include fever, cutaneous eruptions (morbilliform and/or uicarial), lymphadenopathy, and ahralgias. Erythema multiforme may also appear in severe cases. With respect to cefaclor, the incidence of serum sickness is much higher in infants and children than in adults. Due to the severity of the signs and symptoms in this patient, oral prednisone and diphenhydramine should be administered. The prednisone will treat the ahralgias and the skin rash and the diphenhydramine will allete the uicaria. The use of aspirin in a child with a fever is not indicated due to the risk of Reye syndrome. If the patient had not completed his antibiotic therapy and/or signs and symptoms of the infection were still present, switching the antibiotic to a non-beta lactam would be indicated. Prescribing erythromycin for a patient with no signs or symptoms of infection would not be indicated. Intravenous penicillin would not be indicated since there is no infection in this patient, and IV penicillin is reserved for serious infections. In fact, penicillin administration is the most common cause of serum sickness. Ref:Osterhoudt K.C., Penning T.M. (2011). Chapter 4. Drug Toxicity and Poisoning. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
Aspirin and diphenhydramine
Erythromycin and diphenhydramine
Intravenous penicillin and diphenhydramine
Oral prednisone and diphenhydramine: