Having an allergic reaction to Zithromax - Now What?

May 25, 2002

I started it, and within a week my skin was looking so good.. My

doctor even said my skin looked better than he'd ever seen it.

Now I'm very red and I have to stop the Zithromax. Im starting

to have an allergic reaction to it on the night of my

girlfriend's senior ball. When I first was handed the

prescription I asked my doc, my derm, my pharmacist if a

Zithromax allergy was a possibility due to my SEVERE allergy to

clindamycin, and they all emphatically said there was no way it

could happen. Well it has (I recognize the signs) today I

got out of the shower and the entire right side of my back had

this really bad allergic rash. Its since cleared up but I'm sure

it'll get worse before it gets better (Zithromax has a looong

halflife). My face is BRIGHT red and I'm itchy everywhere. This

really sucks. I'm tired of everything going wrong! I literally

can usually predict whats going to happen by asking myself " If I

do this, what is the absolute worst thing that could possibly

happen "

Anyway, to any of the group's resident antibiotic experts.. I've

tried Bactrim. I've been on Minocycline (and dont wanna try doxy

or tetra) and this apparantly eliminates any antibiotic that ends

in mycin, and I don't want to take Metronidazole orally (side

effects). What does this leave me to try that will be useful for

cea (I am gonna only be on it for a few months but I want to

avoid these bad flares until Photoderm is over)

Adam

May 26, 2002

Adam, I don't know what is happening now but I can reassure you: it

is unrelated to your clindamycin reaction. Their common ending has to

do with how they are derived, not with what they are. Although they

both have similiar spectrums of activity, clindamycin and

erythyromycin are classified under two completely different groups of

antibiotics and are not structurally (chemically) related.

Specifically, clindamycin is not a macolide as is erythomycin and

there is no cross-sensitivity between the two antibiotics in any

reference I consulted. Just because two people have the same last

name does not mean they are related.

I'm sorry, but I don't have any recommendations for antibiotics for

you. You've named all the ones I'm familiar with for treating

rosacea. You might as your dermatologist if there's any benefit to

your trying a cephalosporin, which is another class of antibiotics

that get distributed into the skin. But I wouldn't even know which

one to recommend.

I hope this didn't spoil you and your girlfriend's evening. Keep us

posted.

Marjorie

Marjorie Lazoff, MD

> I started it, and within a week my skin was looking so good.. My

> doctor even said my skin looked better than he'd ever seen it.

> Now I'm very red and I have to stop the Zithromax. Im starting

> to have an allergic reaction to it on the night of my

> girlfriend's senior ball. When I first was handed the

> prescription I asked my doc, my derm, my pharmacist if a

> Zithromax allergy was a possibility due to my SEVERE allergy to

> clindamycin, and they all emphatically said there was no way it

> could happen. Well it has (I recognize the signs) today I

> got out of the shower and the entire right side of my back had

> this really bad allergic rash. Its since cleared up but I'm sure

> it'll get worse before it gets better (Zithromax has a looong

> halflife). My face is BRIGHT red and I'm itchy everywhere. This

> really sucks. I'm tired of everything going wrong! I literally

> can usually predict whats going to happen by asking myself " If I

> do this, what is the absolute worst thing that could possibly

> happen "

>

> Anyway, to any of the group's resident antibiotic experts.. I've

> tried Bactrim. I've been on Minocycline (and dont wanna try doxy

> or tetra) and this apparantly eliminates any antibiotic that ends

> in mycin, and I don't want to take Metronidazole orally (side

> effects). What does this leave me to try that will be useful for

> cea (I am gonna only be on it for a few months but I want to

> avoid these bad flares until Photoderm is over)

>

> Adam

>

May 26, 2002

Thanks for the post, I will call my dermatologist on tuesday, and I will ask

what he knows about the cephalosporins. I have to admit though, I am more

confused than ever. Yesturday I called the on-call doctor at my primary

care's office, and when I called my dermatologist's office I got in touch

with his partner. They both told me to stop taking the Zithromax, as it

sounded like a drug reaction, and due to my allergy to clindamycin they were

pretty sure it was the Zithromax. But you, the pharmacist, my primary care

doc, and my derm all have said they are not chemically the same. I stopped

taking the Zithromax after speaking to the two doctors, but for all I know,

there could be something wrong with the water i'm using to take a shower or

something.. (I can't imagine there is anything different about the water in

the last few days, but this is only happening right after I take a shower..

and it has already happened again) Whatever's going on, its too bad this

had to happen, because I was having such great results with the Zithromax!

Re: Having an allergic reaction to Zithromax - Now What?

>

> Adam, I don't know what is happening now but I can reassure you: it

> is unrelated to your clindamycin reaction. Their common ending has to

> do with how they are derived, not with what they are. Although they

> both have similiar spectrums of activity, clindamycin and

> erythyromycin are classified under two completely different groups of

> antibiotics and are not structurally (chemically) related.

> Specifically, clindamycin is not a macolide as is erythomycin and

> there is no cross-sensitivity between the two antibiotics in any

> reference I consulted. Just because two people have the same last

> name does not mean they are related.

>

> I'm sorry, but I don't have any recommendations for antibiotics for

> you. You've named all the ones I'm familiar with for treating

> rosacea. You might as your dermatologist if there's any benefit to

> your trying a cephalosporin, which is another class of antibiotics

> that get distributed into the skin. But I wouldn't even know which

> one to recommend.

>

> I hope this didn't spoil you and your girlfriend's evening. Keep us

> posted.

>

> Marjorie

>

> Marjorie Lazoff, MD

>

> > I started it, and within a week my skin was looking so good.. My

> > doctor even said my skin looked better than he'd ever seen it.

> > Now I'm very red and I have to stop the Zithromax. Im starting

> > to have an allergic reaction to it on the night of my

> > girlfriend's senior ball. When I first was handed the

> > prescription I asked my doc, my derm, my pharmacist if a

> > Zithromax allergy was a possibility due to my SEVERE allergy to

> > clindamycin, and they all emphatically said there was no way it

> > could happen. Well it has (I recognize the signs) today I

> > got out of the shower and the entire right side of my back had

> > this really bad allergic rash. Its since cleared up but I'm sure

> > it'll get worse before it gets better (Zithromax has a looong

> > halflife). My face is BRIGHT red and I'm itchy everywhere. This

> > really sucks. I'm tired of everything going wrong! I literally

> > can usually predict whats going to happen by asking myself " If I

> > do this, what is the absolute worst thing that could possibly

> > happen "

> >

> > Anyway, to any of the group's resident antibiotic experts.. I've

> > tried Bactrim. I've been on Minocycline (and dont wanna try doxy

> > or tetra) and this apparantly eliminates any antibiotic that ends

> > in mycin, and I don't want to take Metronidazole orally (side

> > effects). What does this leave me to try that will be useful for

> > cea (I am gonna only be on it for a few months but I want to

> > avoid these bad flares until Photoderm is over)

> >

> > Adam

> >

May 26, 2002

This is a difficult situation, as zithromax allergy is truly rare.

It could be a side effect and not a true allergy. Nonetheless, it

seriously complicated things. This turn of events suggests getting

on low dose accutane ASAP and stopping further photoderm treatments.

Now, if you want to go the antibtiotic route you have several

options. You will have to construct a skin test for zithromax. This

will indicate if you have a true allergy or not. I don't know if

there is a commercial preparation available, probably not, so you'll

have to have an allergist make one up. Also, make one up for

Biaxin. If you are allergic and want to proceed with a macrolide,

then you can orally desensitize to them in a proceedure similar to

the one used to desensitize for oral Bactrim. Here is the

reference: Arch Dermatolog 133:465-469 Caumes E, et al: Efficacy and

safety of desensitization with sulfamethoxazole and trimethoprim in

48 previously hypersensitive patients infected with human

immunodeficience virus.

Basically over three days or so you take the appropriate fractional

dose. This can be helped by using the oral suspension or the

zithromax powder. You must stay on zithromax chronically or you will

loose your protection against allergy.

Skin testing could turn up that you are not allergic to Biaxin, in

which case, Biaxin 500 mg bid.

Marjorie is right on on the NON relationship between lincosamide

allergy and macrolide allergy.

Other antibiotics to try: Bactrim (most likely to work, though very

high risk of sensitation and very bad stevens johnson reaction

possible) Ceftin (one cephalasporin to try which has been case

reported to work in acne) Very low dose Dapsone (requires weekly

blood tests) (50 - 100 mg/d) never go above 100 mg bid, added to

minocin. Try adding nicomide to minocin.

Now, since minocin isn't working, you might want to culture some

pustules for aerobic and anaerobic bacteria and do a KOH on them as

well. This will help guide your future choice of antibtiocs.

Another option is to try Sulfoxyl lotion once a day, which I have

benefited from. Another option to consider is to agressively treat

any coexisting seborrhiec dermatitis on the scalp, which can

oftentimes improve facial sd and rosacea. ZNP bar to scalp leave on

>5min every day. Since the scalp is closely connected to the face,

calming erythema and scaling on the scalp, helps the neighboring

facial skin. I am now convinced when on antibiotics it is important

to use an anti-yeast treatment for the scalp. The best of which is

ZNP bar. Also, I am convinced it is best to use a benzoyl peroxide

while on antibiotics.