The Rational Clinical Examination
David L. Simel, Drummond Rennie
David L. Simel, John Foxworth, Alan Salkind
The lack of a previous reaction does not guarantee that the child will have no future reaction to...
allergy to penicillin, penicillin, penicillin adverse reaction
"The lack of a previous reaction does not guarantee that the child
will have no future reaction to penicillin or a penicillin derivative,
but the risk is low (about 1%). You can confidently prescribe
penicillin as the preferred antibiotic. Had the child experienced
a previous reaction, the clinician would have to make a decision.
The risk that such a child is truly allergic to penicillin is greater,
given a previous reaction, even though the absolute risk is low.
The decision for how to proceed may depend on your assessment of
the previous reaction, the need for penicillin vs alternative antibiotics,
and the availability of penicillin testing. If the previous reaction
was well documented or an immediate reaction, erythromycin is an
inexpensive treatment for streptococcal pharyngitis so that urgent
skin testing is not necessary...."
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