Treatment of Allergic Reactions to Augmentin

Classification and Treatment

The American Academy of Allergy, Asthma, and Immunology recommends classifying allergic reactions to Augmentin by severity, with Grade 1 being mild, Grade 2 being moderate, Grade 3 being severe, and Grade 4 being life-threatening 1
For mild reactions, the American Academy of Allergy, Asthma, and Immunology suggests discontinuing Augmentin and administering oral antihistamines, such as loratadine 10 mg orally or cetirizine 10 mg orally, with a strength of evidence rated as high 2, 3
For moderate reactions, the American Academy of Allergy, Asthma, and Immunology recommends administering antihistamines and considering adding H2 blockers, such as ranitidine 1-2 mg/kg, with a strength of evidence rated as moderate 2, 3
For severe reactions, the American Academy of Allergy, Asthma, and Immunology suggests epinephrine as first-line treatment, with a dose of 0.01 mg/kg (1:1,000 solution), maximum 0.5 mg per dose, and a strength of evidence rated as high 3

The American Academy of Allergy, Asthma, and Immunology recommends observing patients with mild-moderate reactions for 4-6 hours and patients with severe reactions for at least 6 hours or until stable, with a strength of evidence rated as moderate 2, 3
The American Academy of Allergy, Asthma, and Immunology suggests continuing adjunctive treatment after discharge, including H1 antihistamine, H2 antihistamine, and corticosteroid, with a strength of evidence rated as low 3

The Infectious Diseases Society of America notes that patients with true allergic reactions to Augmentin may have cross-reactivity with other β-lactam antibiotics, with a strength of evidence rated as moderate 5
The Infectious Diseases Society of America recommends avoiding all β-lactams if the reaction was severe and considering non-β-lactam alternatives, with a strength of evidence rated as high 5, 6

The American Academy of Allergy, Asthma, and Immunology emphasizes the importance of not delaying epinephrine administration in anaphylaxis, with a strength of evidence rated as high 3
The American Academy of Allergy, Asthma, and Immunology notes that first-generation antihistamines can exacerbate hypotension and should be used cautiously in hemodynamically unstable patients, with a strength of evidence rated as moderate 2
The American Academy of Allergy, Asthma, and Immunology suggests that corticosteroids do not treat the acute phase of anaphylaxis but may prevent biphasic or protracted reactions, with a strength of evidence rated as low 3