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Amoxicillin Rash: Probably NOT an Allergy

What a relief when amoxicillin provides your child with relief from a painful ear or throat infection. Then, three to five days later, you notice they’ve developed a rash. Now what Does this mean they have an amoxicillin allergy? Probably not. It’s understandable to be concerned, especially in an era of increasingly severe food and environmental allergies and potentially serious reactions. However, as many as 10% of all children who take amoxicillin for a bacterial ear or throat infection develop a rash their first time, and it never returns on future rounds of antibiotics.

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 Amoxicillin Rash

An ampicillin or amoxicillin rash is a skin rash that occurs when a child is taking one of these medicines. The rash usually appears on the 5th day after the child starts taking the medicine, but may appear earlier or as late as the 16th day.

 Child’s Rash After Penicillin: Sensitivity, or Something Else?

I have coauthored a study on this subject, and of 86 pediatric patients who developed an undefined rash following antibiotic ingestion, none showed any sensitivity to penicillin based on the results of skin tests and blood tests. Infectious agents may have caused the rash at the time our patients happened to be on antibiotics, and other ingredients in the suspension formula of the antibiotic, such as yellow and red dyes, could have contributed the rash. I explained to the referring pediatricians of the children in our study that their patients should be allowed to take penicillin again after negative results of a workup for sensitivity.

 Rashes with Amoxicillin

The most common reaction to amoxicillin is a red bumpy rash. We call it an “amoxicillin reaction” or an “Amoxil reaction” (named for the original “brand” of amoxicillin). Do you see little red raised bumps, like mosquito bites, all over the trunk or limbs? It may look very dramatic, but it probably doesn’t itch or bother the child. It usually starts about 5-7 days after the amoxicillin was begun; it fades after a few days with no treatment, even if the amoxicillin is continued. This “Amoxil reaction” is not dangerous, and is not an allergy. It is also not a reason to avoid amoxicillin in the future. We think that it may be an interaction between the amoxicillin and another virus temporarily in the child’s immune system.

Articles of Interest

Amoxicillin Allergy & Amoxicillin Rash Are Often Mislabeled

Mislabeled amoxicillin allergies are an important public health issue because once that label is on a patient’s medical record, it is often never evaluated again. We all know adults who avoid amoxicillin because their parents told them they had an allergic reaction or an amoxicillin rash when they were little. When this adult needs an antibiotic, a non-amoxicillin antibiotic is used, which is often broad-spectrum. This pattern then continues throughout the adult’s life. It’s often stated, “That’s ok, we can just avoid the amoxicillin. There are plenty of alternatives.” However, research has shown that this can actually harm both the patient and the public. Substitutes are more expensive, less effective and have more side effects. For example, a Clostridum difficile (C. diff) infection occurs when a broad-spectrum antibiotic kills off good bacteria in the gut. C. diff infections can be both a life-threatening disease and a long-term, chronic issue.

Amoxicillin Rash in Infectious Mononucleosis

A 7-year-old girl presented with an itchy rash after 1 week of treatment with amoxicillin for pharyngitis. She had erythematous papules and macules on her face, trunk, arms, and legs. The result of a mononuclear spot test was positive, and a diagnosis of amoxicillin rash in infectious mononucleosis was made.

Amoxicillin-Induced Rash in a Child with Epstein-Barr Virus Infection

Antibiotics are known to induce rash in patients with EBV-related infectious mononucleosis. Ampicillin and amoxicillin may be responsible for 90-100% of the cases. The presence of rash associated with antibiotics in these patients can be pathognomonic for EBV infections.

Everything You Need To Know About An Amoxicillin Rash (and more)

One of the most commonly reported side effects of amoxicillin is a skin rash. As the skin is the largest organ in the body, this is at times the most visible when there is a reaction to this medication. As many as 25% of people taking amoxicillin according to research studies will develop a rash who take this medication.

How to Care for your Child’s Ampicillin or Amoxicillin Rash

Maculo-papular rash. This is a flat, red rash on the skin, covered with patches that are small, pale, raised and irregularly spaced. It often occurs three to 10 days after starting the medicine. Give Benadryl to relieve the itch. You do not need any other drug to treat the rash. Stop giving your child the antibiotics and talk to your doctor. They can prescribe your child another type of medicine to treat the infection.

How To Identify And Get Rid Of An Amoxicillin Rash

A maculopapular rash typically: Shows up 3–10 days after a person initially uses the medication. Resembles small, flat, pink spots that appear in a balanced pattern. Begins to diminish after three days but might take up to 6 days to vanish. People using amoxicillin might also develop hives...

Rashes from amoxicillin: Is it a true allergy?

About 5 to 10 percent of children taking amoxicillin or Augmentin will develop a skin rash at some point during the course of the medication. The majority of these reactions are non-allergic, and most are caused by viruses. So, how can you tell the difference?

Skin rash following amoxicillin treatment

At 1 week after initiating amoxicillin treatment, she complained of generalized rashes. Flushing of the face, avoiding the eye area, with painless posterior cervical adenopathy and generalized erythematous papules and macules on the trunk and limbs, except below the knees, were confirmed. What is the diagnosis?