Penicillin Allergies

Dr. Paul Mikhli

This month, it is important to talk about Penicillin allergies. We have a lot of patients who need antibiotics before dental treatments, additionally, we have patients who require antibiotics for infections or to prevent infections when placing implants. The best antibiotic for these circumstances is Amoxicillin which is closely related to Penicillin. The rule is that anybody who has a Penicillin allergy should not be placed on Amoxicillin. This means we must look for another less effective antibiotic for coverage. The next option for these patients has typically been Clindamycin. However, because Clindamycin can lead to C-diff, which, in rare circumstances can be fatal, the current recommendation has been to use Azithromycin as the antibiotic of choice. Azithromycin is not as effective as Amoxicillin, neither is Clindamycin. 

Interestingly, most patients who report a penicillin allergy are not actually allergic to Penicillin. Some studies have shown up to 90% of people who report an allergy are not truly allergic to Penicillin. An upset stomach is not an allergy. A true allergic reaction will cause a rash, hives, or a closing of the airway, no different than a nut or bee allergy. 

Cleveland Clinic is currently launching a campaign to raise awareness and make it easier for patients to be screened if they have a true allergy to penicillin. I encourage Beachwood Dental patients who believe they are allergic to Penicillin to take advantage of this campaign. If you go to a different hospital system, your doctor can still screen you. The process is simple. It will start with an interview to find out if you know for certain you had an actual allergic reaction to Penicillin. If there is any doubt, the follow-up can be with skin testing, or taking a supervised oral dose. 

Being able to take Penicillin has several advantages. First off it is a better antibiotic than many alternatives for treating oral infections. Second, the use of broad-spectrum antibiotics creates an environment that is perfect for the generation of superbugs like MRSA. These infections are resistant to many antibiotics and aside from being a risk to the individual, when they spread, they have the potential to cause a public health crisis. 

So, my message this month is if you think you are allergic to Penicillin, please get tested. You will not only be significantly helping yourself but also helping others to lower the incidences of antibiotic-resistant bacteria outbreaks.  

I am happy to answer any questions that you may have so feel free to reach out to the office at 216-831-5661.  

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