MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 519

rashes, a low fever, or other minor problems, but a few individuals develop severe ana-
phylactic reactions that may be lethal within minutes ( Chapter 23: Allergies ).
Anyone who has suffered anaphylaxis to any of the penicillins must never be treated
withanyofthemagainbecauseapotentiallylethalreactioncouldoccur.Ahistoryofprevi-
ousminorallergicreactionsisnotpredictiveofsuchalife-threateningevent,butpenicillins
should be avoided for individuals who have had minor reactions.
If signs of anaphylaxis develop in a person receiving a penicillin, the drug should be
discontinued immediately. The individual should be warned of the allergy to penicillin and
must tell any future physician or caregiver about it. A bracelet or a tag warning of the al-
lergy must be worn. Participants with allergies to penicillin on a wilderness outing should
inform other members of the party and must make preparations in advance to have other
antibiotics available.
Amoxicillin/Clavulanate
This combination of drugs (Augmentin®) combines amoxicillin (a broad-spectrum
penicillin analog) with clavulanic acid. The acid inactivates a wide variety of lactamases
by blocking active sites of theses enzymes, which are transmitted by plasmids and are re-
sponsible for bacterial resistance to the penicillins and cephalosporins. One of the major
uses for Augmentin® is the treatment of animal bites.
Precautions: The principal risk associated with administration of this drug is allergic
reactions, which have occasionally been fatal. Anyone who has had an allergic reaction to
any of the penicillins should not receive Augmentin®.
The Cephalosporins
The cephalosporins are a group of antibiotics chemically and therapeutically similar to
the penicillins. They are classified as first, second, and third generation. The organisms
against which the first-generation cephalosporins and penicillins are effective are virtually
thesame.Second-andthirdgenerationcephalosporinsareeffectiveagainstadifferentspec-
trum of organisms.
Cephalexin (Keflex® and others) is an orally administered, first-generation ceph-
alosporin used to treat staphylococcal and streptococcal skin- and soft-tissue infections
and urinary tract infections. Ceftriaxone (Rocephin®) is a third-generation cephalosporin
administered intramuscularly and intravenously for treating systemic infections, including
meningitis.
Precautions: A few of the individuals allergic to penicillin are also allergic to the ceph-
alosporins.Anyonewhohashadaseverereactiontopenicillin,particularlyananaphylactic
reaction, must be treated carefully with cephalosporins.
Azithromycin