Penicillin is often the Best Medicine

Penicillin is often the Best Medicine

What if you are sick and you tell the doctor you have an allergy to penicillin? Very often, a type of penicillin is the “Drug of Choice” which is the best antibiotic for that infection.  Yes, there are usually alternatives to penicillins but only 1 out of 100 people actually have a “true” allergy and would not be able to get those types of drugs, in many cases the best drug for that infection.

How do you know if you have a true penicillin allergy?  The first and most important way to know is if you had penicillin at some time and had difficulty breathing, if your throat swelled, or if you had an extreme reaction called anaphylaxis.   One might think a rash qualifies as a penicillin allergy but that is not necessarily an allergic reaction and it should be discussed with your doctor.  Second, it is not a penicillin allergy if you have a stomach ache, nausea or vomiting when you took the drug and neither is it an allergy if a close relative claims a penicillin allergy of their own.

Sometimes people are told that they had an allergic reaction in the past but they do not know what drug or what happened.  There is a test available at Forks Community Hospital if your doctor believes it could clarify your allergy status.  It is not for people with a history of anaphylaxis or difficulty breathing so make sure your doctor knows about those severe reactions.

Why do we care so much about a penicillin allergy?  Are there drugs that are just as good as penicillin that can be used instead of penicillin?  Yes and no.  Of the top 53 infectious bacteria we studied from references, 21 named a type of penicillin as both the top drug and the top alternate for that bacteria; of those, 13 listed penicillin as the top drug only; and 8 listed penicillin as one alternate.   Fourteen bacteria were not treated by penicillin but over three-quarters of the bacteria were best treated by penicillins.

Here are some examples of infectious diseases that should be treated by a penicillin-like drug:  Diabetic foot, diverticulitis, endocarditis, pneumonia (some), strep throat, rheumatic fever, some skin infections, and bites (dog bite, rat bite, bear bite and human bite).

Using the Drug of Choice like these penicillins reduces development of bacterial resistance. Resistance occurs where that particular drug may not kill that bacteria any more.  Using an alternate drug may not end with the best outcome.  Finally, some alternate drugs other than penicillins have more ill effects and in general cost more.

Some people, about 1 in 100 in the US population, actually have that true penicillin allergy.  If other people need to clarify whether they do or not, it could make a difference in being treated for a future infection with the best drug that is a penicillin or even a penicillin alternate.

If we fail to control resistance, by the year 2050 when most of your children or grandchildren are grown, they could die from what we now consider relatively simple infections like strep throat or a dog bite because we will no longer have antibiotics that can save them.

Testing for a penicillin allergy can give valuable information and save future lives.

Check with your doctor who can determine if you are eligible and refer you to the Infection

Nikki Reed, Preventionist at Forks Community Hospital

Disclaimer: This Column is not intended as a diagnosis or recommended treatment of a specific condition. Answers are not a replacement for an individual medical evaluation. Individual health concerns should be evaluated by a licensed clinician.