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I'm an FNP at a family medicine practice. I have a patient who is "allergic" to every family of antibiotics under the sun except Doxycycline. She never has had an anaphylactic reaction to any of the medicines she's tried, just itchy rashes. So she came in for URI x 2 weeks, no fever, productive yellow, thick sputum, + sinus congestion, persisting cough, worse at night, she tried lots of herbal and over the counter treatments with minimal improvement. So I started her on doxycycline 100mg twice daily, no improvement 4 days later. So I was wanting to switch her to Levaquin, she has had a "rash" to levaquin a long time ago, but I was wondering if I could at the same time start her on a medrol dose pack and benedryl to help decrease likelihood of allergic reaction? Is this done? Steroids and benedryl for "allergies" that are not anaphylactic? I've seen similar things done before CT scans for people that have allergies to the contrast dye. Thoughts?
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Have you checked her eosinophil count or CBC?
Has she done a Ct scan of chest yet?
Any history of COAD?
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Hello Sean, If the patient does not have any history of anaphylactic reactions, you can start an antibiotic like levaquin or even get a sputum culture as she has not responded to doxy .Instead of trial on antibiotics, you could get a sputum test done first for better response.The medrol dose pack should be given if the allergic rashes are not controlled through claritin or other prescription anti allergic medicines. If she does not have any history of COAD or asthma, the medrol dose pack is not warranted even to counter allergic reactions. To control the allergic rashes, you can also get her on monteleukast that will help to counteract any excess allergic response induced by the antibiotic.You should also try to get a desensitization test done for allergies through an allergy specialist so that her allergies could be identified and controlled.I hope my answer has helped you.Please remember to rate my service positive once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you!