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Non-immediate penicillin allergy — MRCGP AKT MCQ

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EasyAllergy/ImmunologyNon-immediate penicillin allergyMRCGP AKTUKMLAPARA

A 34-year-old woman develops a widespread morbilliform rash on the seventh day after starting amoxicillin and is still taking it. Her original infective symptoms have resolved. She has no fever, facial oedema, mucosal involvement, skin pain, blistering, lymphadenopathy, breathing difficulty or haemodynamic compromise. What is the most appropriate management?

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Correct answer: B — Stop amoxicillin, document a suspected drug allergy, and offer symptomatic treatment

This is a suspected non-immediate amoxicillin hypersensitivity reaction: a widespread morbilliform exanthem appearing after 7 days, without systemic or severe cutaneous features. Amoxicillin should be stopped, symptoms treated if necessary, and the suspected allergy documented with the drug, timing and nature of the reaction. Continuing amoxicillin risks worsening the reaction. Immediate systemic corticosteroids are not routinely required for a mild uncomplicated exanthem. Cefalexin should not be substituted automatically: her infection has resolved, so no further antibiotic is indicated, and future beta-lactam selection should account for the documented reaction. Admission is unnecessary without anaphylaxis, systemic illness, mucosal disease, blistering, skin pain or other features suggesting a severe cutaneous adverse reaction.

Reference: National Institute for Health and Care Excellence. Drug allergy: diagnosis and management (CG183), Tables 2–3 and recommendations 1.2.3 and 1.4.1. 2014. https://www.nice.org.uk/guidance/cg183/chapter/Recommendations