Cefotaxime-induced allergic reaction in a 4-year-old boy: case presentation and management strategies

• Amol A Joshi,  
• Geeta N Sapkale,  
• Shivshankar M Gunjegaonkar,*  
• Diksha Raosaheb Sasane,  
• Sohail Alibaba Shaikh

Abstract

The present case study aims to report and analyze a hypersensitivity reaction to cefotaxime in a 4-year-old boy, highlighting the clinical presentation, diagnostic investigations, management, and classification of the adverse drug reaction using established systems. Cefotaxime, a third-generation cephalosporin, is a semisynthetic antibiotic derived from "cephalosporin-C," produced by the fungus Cephalosporium. A 4-year-old boy weighing 15 kg presented with a high-grade fever, cold, loss of appetite, and general weakness. He was admitted with a provisional diagnosis of Acute Febrile Illness (AFI) and initiated on parenteral cefotaxime (750 mg BD), along with paracetamol and febrinil. On the second day of therapy, he developed a hypersensitivity reaction characterized by a rash, prompting the discontinuation of cefotaxime. He was treated with antihistamines and hydrocortisone and switched to intravenous amikacin (100 mg BD). The Widal test was positive for antigen O++, with elevated C-reactive protein levels (1.86 mg/dl). Other tests, including dengue, urine analysis, and complete blood count, were within normal limits except for a slight elevation in white blood cells (8.62×10^9/L). Adverse drug reactions (ADRs) to cefotaxime can be classified using the Rawlins-Thompson and DoTS systems. The Rawlins-Thompson system categorizes ADRs into Type A (predictable pharmacological effects) and Type B (unpredictable and serious). The DoTS system considers dose relatedness, timing, and patient susceptibility, providing a comprehensive framework for understanding drug reactions. This case of cefotaxime-induced hypersensitivity falls under Type B in the Rawlins-Thompson classification and is characterized by the DoTS system. Clinicians should be vigilant for ADRs with cefotaxime, despite its general safety. Prompt recognition and management of hypersensitivity reactions are essential to prevent further complications. Discontinuing the offending agent and providing appropriate supportive care is crucial for patient recovery.

Keywords

Cefotaxime, Adverse Drug Reaction, Hypersensitivity, Pediatric,Rawlins-Thompson classification