Intestinal Mucosal Permeability of Children with Cefaclor-associated Serum Sickness-like Reactions

Overview

Journal Eur J Pediatr

Specialty Pediatrics

Date 2013 Jan 9

PMID 23296953

Citations 5

Authors

Zhen Zhang

Yun Xiang

Baoxiang Wang

Hongbo Chen

Xiaofang Cai

Xiaomei Wang

Lin Mei

Yi Zheng

Affiliations

Soon will be listed here.

Abstract

Although the serum sickness-like reaction (SSLR) in children after the administration of cefaclor has long been recognized, the exact mechanism of cefaclor-associated SSLR remains unclear. This study aims to investigate the association between intestinal mucosal permeability and cefaclor-associated SSLR in children. A total of 82 pediatric patients with upper respiratory tract infection following the cefaclor therapy was divided into cefaclor-associated SSLR positive group and negative group based on the presence or absence of SSLR after taking cefaclor, and 30 healthy volunteers served as control group. Urinary lactulose/mannitol (L/M) ratios and serum diamine oxidase (DAO) levels were determined in all cases on days 7, 9, 11, 13, and 15 after oral administration of cefaclor. The children in the control group were given the same measurements after enrollment in this study. From days 7 to 13, the urinary L/M ratio of children with cefaclor SSLR gradually increased and reached to the highest level of 0.38 ± 0.14 on day 13. Compared with the cefaclor-associated SSLR negative group and control group, urinary L/M ratios increased significantly in the cefaclor SSLR positive group on days 7, 9, 11, 13, and 15 after taking cefaclor, and serum levels of DAO following the treatment of cefaclor increased significantly in children with cefaclor SSLR on days 9, 11, 13, and 15. No significant difference in urinary L/M ratios and serum levels of DAO between SSLR negative group and control group through the entire experiment was observed. In conclusion, administration of cefaclor may induce SSLR in children by increasing the intestinal mucosal permeability and/or affecting the integrity of the intestinal mucosa. Determinations of urinary L/M ratios and serum DAO levels may be helpful for observing or predicting the occurrence of SSLR after administration of cefaclor, which will encourage physicians to proceed with extreme caution when prescribing cefaclor for pediatric patients.

Citing Articles

Gut microbiota and host cytochrome P450 characteristics in the pseudo germ-free model: co-contributors to a diverse metabolic landscape.

Wang S, Wen Q, Qin Y, Xia Q, Shen C, Song S Gut Pathog. 2023; 15(1):15.

PMID: 36945019 PMC: 10029254. DOI: 10.1186/s13099-023-00540-5.

Serum sickness reaction to obinutuzumab in a patient with chronic lymphocytic leukaemia.

Elmanaseer O, Avelino A, Azem A, Raval M BMJ Case Rep. 2021; 14(12).

PMID: 34937753 PMC: 8704971. DOI: 10.1136/bcr-2021-245557.

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice.

Peter J, Lehloenya R, Dlamini S, Risma K, White K, Konvinse K J Allergy Clin Immunol Pract. 2017; 5(3):547-563.

PMID: 28483310 PMC: 5424615. DOI: 10.1016/j.jaip.2017.01.025.

Mode of renal replacement therapy determines endotoxemia and neutrophil dysfunction in chronic kidney disease.

Lemesch S, Ribitsch W, Schilcher G, Spindelbock W, Hafner-Giessauf H, Marsche G Sci Rep. 2016; 6:34534.

PMID: 27698480 PMC: 5048306. DOI: 10.1038/srep34534.

Acute gastrointestinal injury in the intensive care unit: a retrospective study.

Chen H, Zhang H, Li W, Wu S, Wang W Ther Clin Risk Manag. 2015; 11:1523-9.

PMID: 26491339 PMC: 4599567. DOI: 10.2147/TCRM.S92829.

References

Linskens R, Huijsdens X, Savelkoul P, Vandenbroucke-Grauls C, Meuwissen S . The bacterial flora in inflammatory bowel disease: current insights in pathogenesis and the influence of antibiotics and probiotics. Scand J Gastroenterol Suppl. 2002; (234):29-40. DOI: 10.1080/003655201753265082. View

Eccles M, Grimshaw J, Johnston M, Steen N, Pitts N, Thomas R . Applying psychological theories to evidence-based clinical practice: identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implement Sci. 2007; 2:26. PMC: 2042498. DOI: 10.1186/1748-5908-2-26. View

Jackson P, Lessof M, Baker R, Ferrett J, Macdonald D . Intestinal permeability in patients with eczema and food allergy. Lancet. 1981; 1(8233):1285-6. DOI: 10.1016/s0140-6736(81)92459-4. View

Benjamin J, Makharia G, Ahuja V, Anand Rajan K, Kalaivani M, Gupta S . Glutamine and whey protein improve intestinal permeability and morphology in patients with Crohn's disease: a randomized controlled trial. Dig Dis Sci. 2011; 57(4):1000-12. DOI: 10.1007/s10620-011-1947-9. View

Menzies I, Laker M, Pounder R, Bull J, Heyer S, Wheeler P . Abnormal intestinal permeability to sugars in villous atrophy. Lancet. 1979; 2(8152):1107-9. DOI: 10.1016/s0140-6736(79)92507-8. View

Parshuram C, Phillips R . Retrospective review of antibiotic-associated serum sickness in children presenting to a paediatric emergency department. Med J Aust. 1998; 169(2):116. View

Ukabam S, Homeida M, Cooper B . Small intestinal permeability in normal Sudanese subjects: evidence of tropical enteropathy. Trans R Soc Trop Med Hyg. 1986; 80(2):204-7. DOI: 10.1016/0035-9203(86)90010-6. View

Chavez-Servin J, Castellote A, Lopez-Sabater M . Analysis of mono- and disaccharides in milk-based formulae by high-performance liquid chromatography with refractive index detection. J Chromatogr A. 2004; 1043(2):211-5. DOI: 10.1016/j.chroma.2004.06.002. View

King B, Geelhoed G . Adverse skin and joint reactions associated with oral antibiotics in children: the role of cefaclor in serum sickness-like reactions. J Paediatr Child Health. 2003; 39(9):677-81. DOI: 10.1046/j.1440-1754.2003.00267.x. View

10.

Cox M, Lewis K, Cooper B . Measurement of small intestinal permeability markers, lactulose, and mannitol in serum: results in celiac disease. Dig Dis Sci. 1999; 44(2):402-6. DOI: 10.1023/a:1026679123148. View

11.

Lanas A, Scarpignato C . Microbial flora in NSAID-induced intestinal damage: a role for antibiotics?. Digestion. 2006; 73 Suppl 1:136-50. DOI: 10.1159/000089789. View

12.

Knowles S, Shapiro L, Shear N . Serious dermatologic reactions in children. Curr Opin Pediatr. 1997; 9(4):388-95. DOI: 10.1097/00008480-199708000-00014. View

13.

Kearns G, Wheeler J, Childress S, Letzig L . Serum sickness-like reactions to cefaclor: role of hepatic metabolism and individual susceptibility. J Pediatr. 1994; 125(5 Pt 1):805-11. View

14.

Kamei H, Hachisuka T, Nakao M, Takagi K . Quick recovery of serum diamine oxidase activity in patients undergoing total gastrectomy by oral enteral nutrition. Am J Surg. 2005; 189(1):38-43. DOI: 10.1016/j.amjsurg.2004.03.015. View

15.

Grouhi M, Hummel D, Roifman C . Anaphylactic reaction to oral cefaclor in a child. Pediatrics. 1999; 103(4):e50. DOI: 10.1542/peds.103.4.e50. View

16.

Fleming S, Kapembwa M, Laker M, Levin G, Griffin G . Rapid and simultaneous determination of lactulose and mannitol in urine, by HPLC with pulsed amperometric detection, for use in studies of intestinal permeability. Clin Chem. 1990; 36(5):797-9. View

17.

Hossain M, Nahar B, Hamadani J, Ahmed T, Roy A, Brown K . Intestinal mucosal permeability of severely underweight and nonmalnourished Bangladeshi children and effects of nutritional rehabilitation. J Pediatr Gastroenterol Nutr. 2010; 51(5):638-44. PMC: 3020319. DOI: 10.1097/MPG.0b013e3181eb3128. View

18.

Stricker B, Tijssen J . Serum sickness-like reactions to cefaclor. J Clin Epidemiol. 1992; 45(10):1177-84. DOI: 10.1016/0895-4356(92)90158-j. View

19.

Soderholm J, Olaison G, Lindberg E, Hannestad U, Vindels A, Tysk C . Different intestinal permeability patterns in relatives and spouses of patients with Crohn's disease: an inherited defect in mucosal defence?. Gut. 1998; 44(1):96-100. PMC: 1760070. DOI: 10.1136/gut.44.1.96. View

20.

Ruan P, Gong Z, Zhang Q . Changes of plasma D(-)-lactate, diamine oxidase and endotoxin in patients with liver cirrhosis. Hepatobiliary Pancreat Dis Int. 2004; 3(1):58-61. View