Drug fever due to i.v. antibiotics

Question

Dear ladies and gentlemen,
my daughter (12 years old) got recently an i.v. antibiotic therapy in hospital due to a markedly worsening of her lung function in the last year. In the first week, the therapy seemed to had a good effect. In the course of the second week, however, she got high fever and extreme chills, that occurred in very regluar time intervals and could be suppressed via the intake of ibuprofen. The treating physician suspected a viral infection and wanted to extend the planned antibiotic course for longer than 14 days, in order to prevent a bacterial infection. Via our own research, we got information about the possibility of a reaction to one of the antibiotics with fever and rush (explicitely mentioned for CF patients as a possible side effect in the leaflet).
The treating CF physician adhered to the viral in fection, the physician in charge did not know anything about a possible side effect like this, however he saw a high possibility for a connection due to the regluar fever curve and the preparation that was given every 8 hours. The last planned dosage was left out according to our wish and in the course of the next day our daughter was at last free of fever. It was strinking to me, that his possibility was not known on the ward, in spite of the fact that children with CF are frequently treated there and I am very worried, in case my daughter should need such a treatment again.
Does such a reaction occur frequently and what shall we do the next time in order not to risk again an allergic reaction?
Many thanks

Answer

Hello,
you report, that your 12-year-old daughter suffered from chills in the frame of an i.v. antibiotic therapy during the second week of treatment; these chills could be successfully suppressed with ibuprofen; however reoccurred after some hours. You report, that this occured in a time dependent manner after the administration of the antibiotics three times a day. The treating physician suspected an accompanying viral infection and negotiated the possibility of a drug side effect. You then refused the last antibitoic administration and report, that your daughter was free of fever the next day.
From my point of view it is not understandable, why a CF physician negotiates the possibility of a drug side effect in such a situation. The physician in charge was for sure right, that he suspected such a connection, especially because the fever attacts were in a timely connected manner to the administration of the antibiotics. It is generally known and also noted in the leaflets of the drug producing companies, that allergic reactions are possible and can be accompanied with fever with or without rush. The frequency of the occurrence of such allergies is different from drug to drug and for sure a certain individual disposition of the patient plays a role. In general such an allergic reaction can even occur in the first therapy cylce. In some patients such a reaction is only seen after several treatment cycles.
You should again discuss the issue with your CF physician and ask for an allergy test concering the mentioned drug of your daughter. Probably you should discuss the problem with an allergologist.
If possible, the drug of suspicion should not be used in the near future. It should also be taken into account, if so-called cross-allergies with other drug groups are known. If there should be no alternative to the causing drug, an anew therapy should be done under strict medical supervision and with emergeny drugs standing by, as when administered the next time, it could also come to massive reactions in the sense of an allergic shock.
We hope, that the problem can be solved for the wealth of your daughter.
Best regards,
Dr. H.-G. Posselt

07.11.2016