What happened to the rash on this girl?

It is only for medical professionals to read for reference.
How to use Amoxicillin? A girl came to the outpatient clinic.
Because of "fever for 4 days, there are'purulent secretions' on the tonsils"", she received intravenous infusion of amoxicillin in the primary hospital.
She soon developed a red rash on her body with obvious itching, as shown in Figure 1 below
.

Figure 1.
Physical examination of the rash on the back of the child: T: 38.
6°C.
Systemic red papules and rashes appeared on the face, trunk, arms and legs, but not on palms and soles
.

The left side of the tonsils Ⅰ°, the right side Ⅱ°, there are "purulent secretions" on them, no severe congestion in the pharynx, swollen lymph nodes can be palpable on both sides of the neck, no abnormalities in the heart and lungs, the abdomen is flat and soft, and the spleen is under the ribs Reachable
.

He was given blood routine test and atypical lymphocyte test, 4 items of Epstein-Barr virus, liver function test, and abdominal ultrasound
.

The results are: (1) Blood routine: WBC: 13.
25X109/L, N: 33.
2%, L: 66.
8%, the proportion of atypical lymphocytes: 15%
.

(2) EB virus antibody test: EB virus IgM antibody is positive
.

(3) Liver function ALT and AST increased slightly; abdominal ultrasound showed a slightly enlarged spleen
.

So far diagnosis: infectious mononucleosis amoxicillin rash
.

Children infected with Epstein-Barr virus are prone to have a measles-like rash when receiving amoxicillin treatment
.

The child was treated with antiviral treatment, amoxicillin was stopped, abdomen protection, anti-allergic treatment, etc.
, and the rash subsided after about 4 days
.

This brings us to our question: As a commonly used antibiotic, amoxicillin, what diseases can it be used for? What diseases are not recommended for? What are the side effects? Amoxicillin indications Amoxicillin is a broad-spectrum semi-synthetic penicillin β-lactam antibiotic.
It is stable under acidic conditions and has a gastrointestinal absorption rate of 90%
.

It is effective against most pathogenic G+ bacteria and G- bacteria
.

Amoxicillin is suitable for the following infections caused by sensitive bacteria (strains that do not produce β-lactamase)
.

(1) Streptococcus hemolyticus, Streptococcus pneumoniae, Staphylococcus, Haemophilus influenzae, etc.
caused by otitis media, sinusitis, pharyngitis, tonsillitis and other upper respiratory tract infections; (2) Escherichia coli, Proteus mirabilis, Enterococcus faecalis (3) Skin and soft tissue infections caused by Streptococcus hemolyticus, Staphylococcus, Escherichia coli; (4) Streptococcus hemolyticus, Streptococcus pneumoniae, Staphylococcus, Haemophilus influenzae, etc.
Causes acute bronchitis, pneumonia and other lower respiratory tract infections; (5) acute simple gonorrhea; (6) can be used to treat typhoid fever, other salmonella infections, and typhoid carriers; (7) leptospirosis
.

Such as Lyme disease, a tick-mediated infection of spirochetes; Professor Neil Skolnik, MD of the United States, in interpreting the latest Lyme disease diagnosis and treatment, proposed: children under 8 years of age, pregnant women and breastfeeding women usually avoid doxycycline , Because of concerns about tooth staining
.

In these populations, β-lactam antibiotics should be used as the first-line treatment, and if allergic to β-lactam, doxycycline should be the second-line option
.

He suggested using amoxicillin as the first choice for the treatment of Lyme disease, because doxycycline can cause phototoxicity [1]
.

Figure 2 shows.
Neil Skolnik, MD discussed the latest Lyme disease treatment and diagnosis on Medscapes (8) Because of its stability under acidic conditions and better absorption, amoxicillin is one of the main drugs for the treatment of Helicobacter pylori
.

Amoxicillin should not be used.
(1) Those who are allergic to penicillin are prohibited
.

(2) People with a history of asthma, eczema, hay fever, urticaria and other allergic diseases should be used with caution; patients with herpes virus infection, especially patients with infectious mononucleosis, such as complicated bacterial infections, can use sensitive antibiotics, but avoid Use ampicillin and amoxicillin to avoid hypersensitivity reactions and aggravate the condition [2]
.

(3) Patients with cytomegalovirus infection, lymphoma, lymphocytic leukemia, etc.
are generally not recommended for use
.

The reason may be: Heterophile antibody-negative infectious mononucleosis is almost half related to cytomegalovirus infection [3]; lymphoma, especially Burkitt lymphoma, is closely related to latent infection of Epstein-Barr virus; amoxicillin The adverse reactions of the disease can cause changes in blood cells such as leukopenia, thrombocytopenia, and anemia.
In addition, patients with leukemia have poor resistance, and strong antibiotics should be used to control the infection as soon as possible
.

(4) Use with caution in pregnant women, breastfeeding women and children under 3 months
.

Because this product can be excreted through milk, the baby can be sensitized by nursing mothers after using this product
.

(5) Generally not used for the treatment of meningitis
.

The reason may be: it is mainly effective against gram-positive cocci, and its antibacterial spectrum is relatively narrow
.

For relatively critically ill patients with bacterial meningitis, the purpose of meningitis treatment is often not well achieved
.

Unless an etiological examination has been carried out, and a drug sensitivity experiment has been carried out indicating that the effect of amoxicillin is ideal, the use of amoxicillin in the treatment of meningitis will be considered
.

Adverse reactions of amoxicillin The adverse reactions of amoxicillin include: (1) Allergic reactions: such as drug fever, urticaria, rash, and asthma, as well as severe anaphylactic shock
.

(2) Digestive system symptoms: diarrhea, nausea, vomiting and other symptoms are more common.
It should be noted that it can cause black hairy tongue and pseudomembranous colitis in clinical application
.

It is worth noting that almost all antibiotics can cause Clostridium difficile-associated diarrhea (CDAD), which may occur within 2 months after stopping treatment; the severity may range from mild diarrhea to fatal colitis; if suspected or Confirm CDAD, immediately stop the application and start the treatment of Clostridium difficile
.

(3) Symptoms of the blood system: eosinophilia, leukopenia, thrombocytopenia, anemia, etc.
can be seen
.

(4) Skin and mucous membranes: maculopapular rash, exudative erythema multiforme, exfoliative dermatitis, Stevens-Jonnson syndrome
.

(5) Liver and kidney function: a small number of patients occasionally saw a slight increase in serum aminotransferase, liver dysfunction (such as cholestatic jaundice, hepatic cholestasis and acute cytolytic hepatitis), acute interstitial nephritis
.

(6) Long-term use of this drug may cause double infections caused by Candida or drug-resistant bacteria
.

(7) Others: convulsions can be seen when the intravenous injection is large; Zhu Yonggui and others reported that the use of amoxicillin and sulbactam caused gross hematuria in children, etc.
[4]
.

References: [1] Neil Skolnik, MD.
Lyme Disease: The Latest Guidelines on Testing, Prophylaxis, and Treatment.
Medscape Pediatrics (American), DISCLOSURES June 04, 2021.
[2] Infection Group, Pediatric Branch of Chinese Medical Association, National Children’s Epstein-Barr Virus Infection Cooperative Group.
Principles and recommendations for the diagnosis and treatment of major non-neoplastic Epstein-Barr virus infection-related diseases in children.
Chinese Journal of Pediatrics, 2016, 54 (8): 563-568.
[3] Wang Weiping, editor in chief.
Pediatrics (National College textbook 8th edition).
People's Medical Publishing House.
[4] Zhu Yonggui, Yang Zuocheng.
A case of gross hematuria in children caused by amoxicillin-sulbactam.
Journal of Pediatric Pharmacy, 2010, 16 (4): Ⅱ.