This study found a lower incidence of antibiotic-associated rash in children with Epstein-Barr virus acute infectious mononucleosis than previously reported.

"Ampicillin rash" associated with Epstein-Barr virus (EBV) acute infectious mononucleosis (AIM) was first described in the 1960s and reported to occur in 80% to 100% of treated patients. Ever since then, the dogma of ampicillin rash associated with EBV has been passed along as infectious diseases gospel. Researchers in Israel reexamined the incidence of rash associated with antibiotic treatment in children with EBV-AIM in a retrospective record review of 238 patients with serologically diagnosed EBV infection in two hospitals between 1999 and 2009.

Rash developed in 33% of the 173 patients who received antibiotics and 23% of the 65 untreated patients. Although this difference was not significant, the rate of rash in treated patients who received amoxicillin was significantly higher (39%) than the rate in untreated patients. Amoxicillin was associated with a significantly higher rate of rash (30%) than other antibiotics. Among treated patients, those with submandibular lymph node enlargement, dysphagia, and elevated white blood cell counts were less likely to develop antibiotic-associated rash. No other clinical predictors of rash were identified.

CITATION(S):

Chovel-Sella A et al. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pediatrics 2013 May 1; 131:e1424.