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Content Update

Sept. 13, 2018

Updated Recommendation for Doxycycline Use in Children: The U.S. Food and Drug Administration (FDA) requires all tetracycline products to carry a warning that drugs in this class may cause permanent discoloration of teeth when used in children up to the age of eight years and that tetracycline drugs should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated. However, based on evidence that doxycycline causes minimal enamel hypoplasia and staining of developing teeth in children, the American Academy of Pediatrics (AAP) recently updated its recommendation to state that doxycycline can now be used in children of all ages for a duration of 21 days or less.

Content Update

Jully 3, 2018

Risk of Methicillin-resistant Staphylococcus aureus and Clostridium difficile Infection with Documented Penicillin Allergy: Many patients are labelled as penicillin allergic but do not have true immediate penicillin hypersensitivity. This can lead to unnecessary administration of broad-spectrum antimicrobials, which can promote emergence of antimicrobial resistance (eg, MRSA) and development of healthcare-associated infections such as C. difficile. A recent report demonstrated that patients with documented penicillin allergy have a higher risk of infections with MRSA and C. difficile. The report supports the principle of using the most narrow spectrum antimicrobial that is effective to treat an infection, and that unnecessary use of broad-spectrum antimicrobials increases the risk of bacterial resistance and emergence of superinfections. When penicillin allergy is suspected, efforts should be made to determine if the patient experienced an immediate hypersensitivity reaction.


For the chapter in the Wells Handbook, please go to Chapter 35. Antimicrobial Regimen Selection.



  • Image not available. Every attempt should be made to obtain specimens for culture and sensitivity testing prior to initiating antibiotics.

  • Image not available. Empirical antibiotic therapy should be based on knowledge of likely pathogens for the site of infection, information from patient history (eg, recent hospitalizations, work-related exposure, travel, and pets), and local susceptibility.

  • Image not available. Patients with delayed dermatologic reactions (ie, rash) to penicillin generally can receive cephalosporins. Patients with type I hypersensitivity reactions (ie, anaphylaxis) to penicillins should not receive cephalosporins. Alternatives to the cephalosporins include aztreonam, quinolones, sulfonamide antibiotics, or vancomycin based on type of coverage indicated.

  • Image not available. Creatinine clearance should be estimated for every patient who is to receive antibiotics and the antibiotic dose interval adjusted accordingly. Hepatic function should be considered for drugs eliminated through the hepatobiliary system, such as clindamycin, erythromycin, and metronidazole.

  • Image not available. All concomitant drugs and nutritional supplements should be reviewed when an antibiotic is added to a patient’s therapy to ensure drug–drug interactions will be avoided.

  • Image not available. Combination antibiotic therapy may be indicated for polymicrobial infections (eg, intra-abdominal and gynecologic infections), to produce synergistic killing (such as β-lactam plus aminoglycoside vs Pseudomonas aeruginosa), or to prevent the emergence ...

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