Case Description
Several years ago, an older man visited the clinic where I practiced. He complained to the physician about pain in his right ear, smelly discharge, and partial hearing loss, and it looked unhealthy. A medical examination revealed that the man had malignant otitis externa.
The physician was about to prescribe him semisynthetic penicillin as part of his drug treatment, but found that the patient was allergic to penicillin in his medical history. However, the older man said he only had a mild allergic reaction, namely redness and itching, when he was a teenager. He also shared that when he was 43, and his right ear was infected for the first time, he insisted on penicillin medication, and there was no allergic reaction.
Ultimately, the healthcare professional allowed him to take penicillin, baseline antibiotics. The immune system’s response type was defined and refined, as advised by experts (Rosenthal & Burchum, 2021). The older adult returned to the clinic two days later with a swollen, red face; an allergic reaction was identified.
Explanation of Penicillin Allergy
Pharmacokinetics and pharmacodynamics explain the recurrence of penicillin allergy. The factors responsible for this are genetics and age. The person was initially predisposed to a more aggressive immune response to penicillin. Itching and redness in adolescence were triggered by the immune system being influenced by sex hormones and intense bodily transformation. The new reaction was likely due to reduced antibiotic absorption caused by age-related physiological changes, leading to a more pronounced drug effect.
The individual who suffered from both malignant otitis externa and allergic response needed a safer plan of care, and one will be provided here. Such and similar practices enhance knowledge regarding prescribing and medicinal treatment (Sabatino et al., 2017). The first factor one must consider when designing a care plan for older people is that its core must be evidence-based (2019 American Geriatrics Society Beers Criteria Update Expert Panel, 2019). Medication should include a fluoroquinolone antibiotic, namely Temafloxacin, and antihistamines, both to be taken in small doses. The latter must meet at least the standards of Schedule V substances, that is, be the safest (Drug Enforcement Administration, n.d.).
Muanda et al. (2022) argue that fluoroquinolones in high doses are dangerous to older individuals. Their inferences are based on patients with chronic kidney disease, but these are also applicable to the described case. He should be provided with an in-home personal caregiver or teleconsultations during the treatment process for supervision.
References
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694.
Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. DEA Diversion Control Division.
Muanda, F. T., Sood, M. M., Weir, M. A., Sontrop, J. M., Ahmadi, F., Yoo, E., Kim, R. B., Silverman, M. S., Knoll, G. A., & Garg, A. X. (2022). Association of higher-dose fluoroquinolone therapy with serious adverse events in older adults with advanced chronic kidney disease. JAMA Network Open, 5(8), 1-13.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248-254.