Amoxicillin Challenge Protocol

Vital Signs & Monitoring

Monitor vital signs (HR, RR and BP) at baseline, 20 minutes and 80 minutes after the challenge begins

Medical evaluation indicated if:

HR greater than 30 beats/minute above baseline
RR greater than 10 breaths/minute above baseline
BP increase or decrease more than 20 mmHg from baseline
Wheezing, chills, rash, urticaria, flushing, myalgias, CNS or behaviour change, headache or other unusual symptoms

Ensure that epinephrine is available the ward or office and that it can be given within 5 minutes. As a precaution, calculate dose of epinephrine.

Protocol - Amoxicillin Challenge

Step 1

Amoxicillin suspension 5 mg/kg/dose (maximum dose 50 mg) orally x 1 dose
Monitor vital signs (HR, RR and BP) 20 minutes after dose. If no hypotension, continue with step 2

Step 2

Amoxicillin suspension 20 mg/kg/dose (maximum dose 450 mg) orally x 1 dose
Monitor vital signs (HR, RR and BP) 60 minutes after dose

Protocol - Other Antibiotics

Based on history and if indicated for treatment of a current infection, it is possible to perform a challenge with other antibiotics

Step 1

Give 10% of dose of selected antibiotic
Monitor vital signs (HR, RR and BP) 20 minutes after dose. If no hypotension, continue with step 2

Step 2

Give the remaining 90% of dose
Monitor vital signs (HR, RR and BP) 60 minutes after dose

Acute Management of Reactions