A mother brings her two years old child to ED after 2 hours from ingesting unknown amount of his old medicine.Child is very active and jumping all over the ED.Vital signs and examination unremarkable.
Q1.What are the expected toxicity ?
Q2.What is your management plan?
Jumpy Child
Thanks for your comments
No much reported are available for clarithromycin and macrolide overdose,
Acute oral overdose of antibiotics is uncommon and usually cause GI symptoms . Serious toxicity have not been reported in general after single oral overdose, Acute toxicity is more likely to be seen after inadvertent IV injections like anaphylaxis
Neurotoxicity, cardiotoxicity and some acute kidney injury have been reported in context of chronic toxicity in renal patients
Treatment in general in supportive ,
If child remain asymptomatic can be discharged after few hours observation
References:
Terry King-Wing Ma et al , Clinical manifestation of macrolide antibiotic toxicity in CKD and dialysis patients. Clinical Kidney Journal, Volume 7, Issue 6, December 2014, Pages 507–512,
After search
Could not find alot about clarithromycin toxicity
Clarithromycin toxicity
-GI symptoms-nausea ,vomiting,dyspepsia,abdominal discomfort
-anaphylaxis
-cardiac-QTc prolongation
——————
Plan :
Observe in ER for couple of hours(t1/2 of clarithromycin is 3-4hrs)
-So will start with
-ABCDE
-vitals(Spo2,temp,Bp,HR,RR)-already mentioned as normal
-RBS
-ECG (calculate QTc )
-send and trace LFT,RFT
-observe for any anaphylactic symptoms,GI or cardiovascular instability)
-no need to keep NPO as he is stable and low risk(as he most likely did not shake the bottle before drinking and it is an old medication)
-discharge with advise
-keep drugs away from children-preventing such future events
-come to ED if develop any of the following:LOC,lethargy,irritability,persistent vomiting,poor feeding,SOB
Git upset,hepatotoxicity,hypersensitivity, arrhythmia
,managment by elemenation procedures,observation,serum level.