Evaluation of Suspected Antibiotic Allergies

Antibiotic-associated adverse drug reactions are often mild (eg, nausea or diarrhea) and typically occur 1 to 6 hours after drug exposure. IgE-mediated reactions cause urticaria, angioedema, bronchospasm, or, in severe cases, anaphylaxis. Cell-mediated delayed hypersensitivity can occur over days to weeks, most commonly as benign cutaneous morbilliform eruptions, although more severe manifestations, such as Stevens-Johnson syndrome, may occur.

The guideline provides evidence-based recommendations for evaluating possible drug allergy in nonsteroidal anti-inflammatory drugs, chemotherapies, immune checkpoint inhibitors, biologic agents, and excipients (inactive substances formulated with pharmaceuticals). This JAMA Clinical Guidelines Synopsis focuses on practice recommendations for antibiotic allergy evaluation.

Author/s:

Ruchi Singla, Megan C Elios, Andrew M Davis

Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage

Brian Desmarais — Tue, 11 Feb 2020 17:21:11 +0000

Date Added:

February 11, 2020

Journal/Publication:

JRSM Open

Publisher:

Journal of the Royal Society of Medicine

Publication Date:

May 1, 2017

Issue:

Volume:

URL:

Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1177/2054270417694291

Keywords

common cold

randomised controlled trials

respiratory tract infections

therapeutic equivalency

MeSH

Zinc Acetate

gluconic acid

Gluconates

Drug Hypersensitivity

tablets

In case you missed this 2017 meta-analysis. Advise patients that the dosage and type of zinc matters, and the product they choose should not contain citrate, which binds zinc, reducing its absorption. James W. Mold, MD, MPH

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OBJECTIVE:

To compare the efficacy of zinc acetate lozenges with zinc gluconate lozenges in common cold treatment and to examine the dose-dependency of the effect.

DESIGN:

Meta-analysis.

SETTING:

Placebo-controlled zinc lozenge trials, in which the zinc dose was > 75 mg/day. The pooled effect of zinc lozenges on common cold duration was calculated by using inverse-variance random-effects method.

PARTICIPANTS:

Seven randomised trials with 575 participants with naturally acquired common colds.

MAIN OUTCOME MEASURE:

Duration of the common cold.

RESULTS:

The mean common cold duration was 33% (95% CI 21% to 45%) shorter for the zinc groups of the seven included trials. Three trials that used lozenges composed of zinc acetate found that colds were shortened by 40% and four trials that used zinc gluconate by 28%. The difference between the two salts was not significant: 12 percentage points (95% CI: -12 to + 36). Five trials used zinc doses of 80-92 mg/day, common cold duration was reduced by 33%, and two trials used zinc doses of 192-207 mg/day and found an effect of 35%. The difference between the high-dose and low-dose zinc trials was not significant: 2 percentage points (95% CI: -29 to + 32).

CONCLUSIONS:

Properly composed zinc gluconate lozenges may be as effective as zinc acetate lozenges. There is no evidence that zinc doses over 100 mg/day might lead to greater efficacy in the treatment of the common cold. Common cold patients may be encouraged to try zinc lozenges for treating their colds. The optimal lozenge composition and dosage scheme need to be investigated further.

Author/s:

Hemilia, H.