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Protocol 8.13


Antibiotic skin test and challenge
Author(s):Dr Rosie Hague, Maureen
Lilley, Jenny Macdonald
Review: December 2008

Version: 1.2
Authorised by:

Page 1 of 4
Issue Date:


Reviewed: December 2006

RHSC PROTOCOL 8. Characteristics of the nurse performing antibiotic skin testing and challenge The nurse practitioner will be deemed competent by: • Demonstrating capabilities with regards to safe and competent practice • Receiving recognised practical training • Having completed the Paediatric Advanced Life Support Course The nurse practitioner must adhere to the following: Yorkhill Division Policy on ‘The Scope of Professional Practice’ Yorkhill Division Protocol on Management of ‘Anaphylaxis’ Yorkhill Division ‘Nursing and Midwifery Medicine Policy’ Yorkhill Division Protocol ‘Skin Prick Testing’ Nursing and Midwifery Council ‘Standards for Administration of Medicines’ (2002) 1. Conditions Under Which Protocol can be used 1. 1. Medical advice must be sought when necessary.2 Authorised by: Page 2 of 4 Issue Date: Q-Pulse: Reviewed: December 2006 . Maureen Lilley. Practical guidelines are attached for reference and to standardise the quality Antibiotic skin test and challenge Author(s):Dr Rosie Hague. Medication and resuscitation equipment must be readily available as per Anaphylaxis Protocol.3 A named doctor must be informed that the procedure is being carried out.5 6 1. The referring medical practitioner must prescribe the antibiotics used for testing on a drug kardex.13 Protocol: Antibiotic Skin Test and Challenge Statement As a registered nurse the nurse practitioner is personally accountable for his/her practice and in exercising accountability may therefore enhance his/her skills by performing antibiotic skin testing and challenge.2 The procedure should be fully explained to the child and parent(s) by the nurse practitioner carrying out the procedure. seeking their co-operation when necessary to ensure patient needs are met.6 7 8 1. Jenny Macdonald Review: December 2008 Version: 1. No antibiotic should be given in the 2 weeks before the test date 2-4 weeks prior to the test date. Consent must be obtained by the nurse practitioner/doctor if an oral antibiotic challenge is indicated.4 4 5 1.7 The child must be well and have no need of antibiotics at the time of testing. 2 3 1. The nurse practitioner will work in partnership with medical staff. 1.1 No antihistamine should be given 48 hours before.13 Women & Children’s Service Yorkhill Site Nursing and Midwifery Policy Committee Protocol No: 8.

3. The resulting weal (size dependent) can help identify whether a child has the potential to react to an antibiotic and whether or not an oral challenge is indicated.25mm) positive allergy to antibiotic tested. Erythema and Weal Response <5x5mm (25mm) proceed to intradermal test dose 3. A positive skin prick tests results in a wheal.2 Precautions: The likelihood of systemic manifestations are low however intramuscular Epinephrine (1:1000) together with other supportive measures must be readily available. • A sterile blood lancet is placed on the skin with the tip in the drop of solution.4 Procedure • The selected site for the test should be either on the forearm or the back of the child being tested • A ballpoint pen should be used to mark the site(s) were the antibiotic allergen(s) will be placed together with sites for positive and negative controls. which occurs within 15 minutes after the skin is prick tested. Interpretation of Results Both weal and erythema are measured and recorded. Excess solution should be blotted off with a tissue. • After 15 minutes the results are interpreted. just enough to make an indent without breaking the skin. Antibiotic Skin Testing and Oral Challenge Practice Guidelines 2. 2. >3x3mm (>9mm) but <5x5mm (<25mm) borderline positive If intradermal skin test negative oral challenge indicated Antibiotic skin test and challenge Author(s):Dr Rosie Hague.1 Results of Skin Prick Testing: Erythema and Weal Response 5x5mm (>25mm) positive no further testing indicated.13 2. • One drop of the prepared antibiotic solution is placed on the skin using a dropper. 2.2 General Guidelines for Intradermal Test Dose: • Administer an intradermal test dose of 0.3 Equipment required As per Yorkhill Division Skin Prick Testing Protocol (Protocol 8. The tip of the lancet is then pushed gently into the skin.3 Results of Intradermal Test Dose: Erythema and Weal at Injection Site Erythema and Weal at Injection Site 5x5mm (. If more than one antibiotic is to be tested they should be placed at least 3mm apart.2 Authorised by: Page 3 of 4 Issue Date: Q-Pulse: Reviewed: December 2006 . 3. A positive and negative control should also be used.2) 2. Jenny Macdonald Review: December 2008 Version: 1. Maureen Lilley.02ml of the antibiotic to be tested (1mg/1ml).RHSC Protocol 8. • After 15 minutes the results are interpreted 3. The reactions are graded according to the Bencard grading system.1 Principle: The response provoked by skin prick testing is an IgE mediated response.

Pichichero. If no reaction. E. Oral challenge following negative Intradermal skin test: (FOLLOW PROTOCOLS FOR SPECIFIC ANTIBIOTICS) Weight < Than 40lbs (< 16kgs) Weight > Than 40lbs (> 16kgs) 125mg of antibiotic tablet orally 250mg antibiotic tablet orally …….. References: Duff. Evaluation of Skin Testing in the Diagnosis of IgE-Mediated Disease Paediatric Clinics of North America 30:785 (1983) Authors: Dr Rosie Hague.13 4. Pichichero. Jenny Macdonald Review: December 2008 Version: 1. Maureen Lilley. Pharmacist Medicines Information Names of Nurses authorised under protocol: Maureen Lilley. et al The Relevance of Sensitivity to Allergy Paediatric Clinics of North America 39:1277 (1992).RHSC Protocol 8. W. *This might not always be the case and depends on the antibiotic. The dose listed above is used for penicillin V. D. a 5 to 10 day course of the same antibiotic is administered at home. ampicillin. amoxicillin and cephalosporin allergy: Reliability of examination assessed by skin testing and oral challenge The Journal of Paediatrics Jan. The Scope of Professional Practice UKCC 1992.2 Authorised by: Page 4 of 4 Issue Date: Q-Pulse: Reviewed: December 2006 .. L. Tipton. Monitor for 2 hour post challenge. A. 1998. Consultant in Infectious Diseases and Immunology Maureen Lilley. Paediatric Advanced Nurse Practitioner Jenny Macdonald. Diagnosis of penicillin. 137-143. The child should have an antihistamine to use if symptoms develop during this time. M. Paediatric Advances Nurse Practitioner Allison McLaughlin. R. Paediatric Nurse Practitioner Ratified: Head of Nursing Date: Review Date: December 2008 Reviewed December 2006 Review December 2008 Antibiotic skin test and challenge Author(s):Dr Rosie Hague. and erythromycin.