A case of ribostamycin-induced anaphylaxis / 대한내과학회지

Anaphylaxis is a life-threatening, systemic reaction manifested by urticaria, angioedema, bronchospasm, syncope and hypotension, which occurs after the exposure to specific antigen such as antibiotics, aspirin, nonsteroidal antiinflammatory drugs, foods, bee sting, or exercise. A 33-year-old woman suffering from anaphylactoid attack after intramuscular administration of ribostamycin at private clinic, was visited to our emergency room and admitted. She had allergic rhinitis and her 8-year-old daughter had atopic dermatitis. She had three previous intramuscular administrations of ribostamycin at every three weeks due to recurrent pelvic inflammatory disease. At third time of ribostamycin administration, she had experienced generalized pruritus, flushing and shortness of breath but these symptoms were resolved spontaneously without medication. Therefore, she didn't notice to attending physician. During the fourth administration of ribostamycin, she developed generalized urticaria and angioedema with dyspnea, dizziness, and severe hypotension. We experienced a case of ribostamycin-induced anaphylaxis, which is rarely mentioned in published articles. We performed a skin prick test and an intradermal test to ribostamycin, which were positive, and report a case of ribostamycin-induced anaphyalxis.

Antibiotics prescription pattern of family practitioners for respiratory tract infections

BACKGROUND: Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections. METHODS: In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview. RESULTS: The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI=1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)posssibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%). CONCLUSION: Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influence by patient's age, number of clinic-visit, and clinical symptoms and signs.