Antibiotic Exposure Increases the Risk of Rash in Children with Infectious Mononucleosis

Recent evidence suggests that antibiotic use, particularly aminopenicillins – like amoxicillin, could heighten the likelihood of rash in children with infectious mononucleosis (IM). 

A new retrospective study investigated the link between antibiotic exposure and rash risk in IM-affected children. This multicenter cohort study included 767 children with IM, aged 0-18 years, from 14 hospitals in Guizhou Province, China. 

The analysis indicated that antibiotic exposure was connected to a notable rise in the overall incidence of rash in IM children. Out of 92 rash cases, 43 showed connections with antibiotic use. Of these, two cases (4.08%) involved amoxicillin, while 41 (8.15%) were attributed to other antibiotics. The results suggested that the risk of rash due to amoxicillin use was comparable to that of other penicillins, cephalosporins, or macrolides. 

The findings emphasize the importance of cautious monitoring for rash occurrence in IM children on antibiotic therapy, rather than arbitrarily avoiding amoxicillin prescriptions. This study addressed the common practice of prescribing antibiotics based solely on symptoms, as IM and acute bacterial tonsillitis share similar presentations. 

Despite recommendations against amoxicillin use in IM patients by the National Institute for Health and Care Excellence (NICE), this study's findings challenge the perception that alternative antibiotics, such as other penicillins, cephalosporins, or macrolides, carry a lower risk of rash. Given the frequent use of amoxicillin in treating pediatric infectious diseases, the study suggests clinicians should remain vigilant for rash development in IM children on antibiotic therapy without automatically excluding amoxicillin from prescription options.

Source: Zhang R, Mao Z, Xu C, et al. Antimicrobial Agents and Chemotherapy. 2023 Jun 15;67(6):e00249-23.