How to prepare cephalosporin skin test solution?

1. 1 preparation of skin test solution Take 1 serving of penicillin skin test solution (containing 2500 units of penicillin sodium), add 5ml of sodium chloride injection to dissolve and dilute it (containing 500 units of penicillin /ml). This product can be used for 24 hours after dilution.

1.2 skin test method and observation results: disinfect the skin 2 inches above the forearm flexion joint, extract about 0. 1ml skin test solution for intradermal injection (0.02~0.03ml for children), and after 20 minutes, if central halo and peripheral erythema appear locally, the diameter is larger than lcm, or local redness or blisters appear, it is positive; For those suspected of positive reaction, sodium chloride should be injected into the other forearm for control test.

1.3 Note: Very few patients may have anaphylactic shock during skin test, which usually starts within a few seconds to 5 minutes after injection. At first, the skin was itchy and the limbs were numb, followed by shortness of breath, chest tightness, cyanosis, rapid heartbeat, weak pulse, decreased blood pressure and profuse sweating. The patient may die if he is not rescued in time. Therefore, we should be prepared for rescue, such as standing adrenaline hydrochloride, hydrocortisone, central stimulants, anti-allergic drugs and so on.

2 Other penicillins (ampicillin, carbenicillin, oxacillin, piperacillin)

2. Preparation of1skin test solution:

0.5g/ bottle, sodium chloride injection to 1ml-→ 500mg/ml.

Take 0. 1 ml and add sodium chloride injection to 1 ml-→ 50mg/ml.

Take 0. 1 ml and add sodium chloride injection to 1 ml-→ 5mg/ml.

Take 0. 1 ml and add sodium chloride injection to 1 ml -→0.5 mg/ml.

2.2 Skin test method and observation results:

Take 0. 1ml(50 ug) for intradermal injection, and those who are positive are prohibited.

3 Bonda (piperacillin sodium/tazobactam sodium)

3. Preparation of1skin test solution:

Take Bangda (skin trial, each containing piperacillin sodium/tazobactam sodium 2.5mg) and inject 5ml of water for injection to make 500ug/ml skin test solution.

3.2 Skin test method and observation results:

Take 0. 1ml(50 ug) for intradermal injection, and those who are positive are prohibited.

Preparation method of skin test solution of cephalosporin antibiotics

China Pharmacopoeia does not explicitly require cephalosporins to undergo allergy test, but those with allergic history or constitution should undergo skin allergy test according to the situation. There is no uniform regulation on the concentration of skin test solution, and it is generally stipulated that the skin test solution is 0.5 mg/ml. The following is the preparation method of cephalosporin skin test solution for clinical reference.

4. Preparation of1skin test solution:

4. 1. 1. 1g cephalosporin +2ml sodium chloride injection to prepare 500mg/ml solution (solution a);

4. 1.2 Absorb 50 mg/ml solution A (solution B)0. 1ml+0.9ml sodium chloride injection with lml injection;

4. 1.3 Remove 0.9ml, and add 0. 1ml+ 0.9ml of sodium chloride injection to obtain 5 mg/ml solution (solution C);

4. 1.4 Push off 0.9ml, leaving 0. 1ml+ 0.9ml of sodium chloride injection to obtain 0.5 mg/ml of skin test solution (solution D).

If the cephalosporin is 0.5g/ bottle, after the first dilution, take 0.2ml+ solution A and 0.8ml sodium chloride injection of 50 mg/ml solution (solution B), and the rest are the same as those in Part 3 and 4.

4.2 Skin test method and observation results:

Inject 0. 1 ml of D solution into the endothelium of the lower metacarpal segment of forearm, and after 1.5-20 minutes, observe that the local skin is red and swollen, and the diameter is more than 1cm, which is positive (+).

Streptomycin 5

5. Preparation of1skin test solution:

5. 1. 1 Take streptomycin 1 g (1 10,000 units) and add 3.5ml of sodium chloride injection, then dissolve it into 4 ml (25 250,000 units/m1);

5. 1.2 Take 0. 1 ml supernatant and add 0.9 ml sodium chloride injection to make 25,000 units/ml;

5. 1.3 Take 0. 1 ml solution (2) and add 0.9 ml sodium chloride injection to make 2500 units/ml;

5. 1.4 Take 0.2 ml of solution (3) and add 0.8 ml of sodium chloride injection to make 500 units/ml.

5.2 Skin test method and observation results:

Take 0. 1 ml (50 units) skin test solution for intradermal test and observe for 20 minutes. Its judgment standard is the same as penicillin.

5.3 Precautions: Patients with negative skin test may also have allergic reactions during injection, so be prepared for rescue. At present, there is no unified skin test method in China, and it has been stipulated that the areas of skin test should adhere to it.

6 purified protein derivative of tuberculin (PPD)

6. Preparation of1skin test solution:

PPD stock solution (50u/ml).

6.2 Skin test method and observation results: Suck the above liquid 0. 1ml(5u), inject it intradermally into the palm of forearm with Mendel method, and check the reaction of injection site 48-72 hours after injection. Measurements should be recorded by the number of millimeters of lateral warping and the vertical diameter of induration. The average diameter of the reaction is ≥5mm, which is a positive reaction. Anyone with blisters, necrosis and lymphangitis is a strong positive reaction, which should be explained in detail.

Tetanus antitoxin serum

7. Preparation of1skin test solution:

Take 0. 1 ml serum and add 0.9 ml sodium chloride injection.

7.2 Skin test method and observation results:

Take 0. 1 ml skin test solution and do intradermal test in forearm. Observe 15 minutes, and the swelling above 1cm is positive. At the same time, sodium chloride should be injected into the other forearm for control test.

7.3 Preventive measures:

Desensitization injection method: inject 10 dilution, 0.2 ml, 0.4 ml and 0.8ml3 three times, with an interval of 30min each time. If there is no response, inject the rest.

8 cytochrome c

8. 1 Preparation of skin test solution: stock solution.

8.2 Skin test method and observation results:

8.2. 1 scratch method: scratch the skin inside the forearm with 1 drop, and observe for 20 minutes. If the redness exceeds 10mm or the swelling exceeds 7mm, it is positive.

8.2.2 intradermal method: Dilute this product to 0.03mg/ml and inject 0.03-0.05ml intradermally. After 20 minutes, the redness diameter is above 15mm or the swelling is above lOmm.

8.2.3 Eye drop method: Drop this product with a concentration of 1 drop of 5 mg/ml on the conjunctiva. After 20 minutes, conjunctival congestion and edema, itching is positive.

8.3 Preventive measures:

It is reported that foreign countries may occasionally cause allergic reactions. Although no allergic reaction has been found in domestic clinical application, we should be vigilant, especially when taking drugs again after stopping taking drugs.

9 organic iodine contrast agents (iodopyrazine, sodium acetate sulfonate, meglumine diatrizoate, meglumine diatrizoate, sodium cholate, iodized oil, etc.). )

9. Preparation of1skin test solution:

30% organic iodine solution.

9.2 Skin test method and observation results:

9.2. 1 intravenous injection method: intravenous injection of 30% organic iodine solution lml, and close observation 10 minute, whether there are any uncomfortable reactions such as palpitation, buccal edema, nausea, vomiting, urticaria and blood pressure drop. If there is the above phenomenon, injection is not allowed.

9.2.2 Oral examination method: put 1-5ml contrast agent into the oral cavity, and observe whether there is the above reaction after 5min.

9.2.3 intradermal injection method: inject 0.05-0. 1ml contrast agent into the skin, and after 10- 15 minutes, if there is a reaction erythema with the size of lcm, it will be a strong positive.

9.2.4 Conjunctiva test method: Drop 1-2 drops of contrast agent into one conjunctival sac, and after 1 min, observe the congestion of conjunctiva and sclera (compared with the opposite side). If there is obvious congestion, vasodilation and varicose veins are strongly positive.

9.3 Precautions: If the allergy test is negative, allergic reaction may still occur when iodine is compared, which should be paid attention to.

10 asparaginase

10. 1 preparation of skin test solution;

Add 0.9% sodium chloride injection lml to an ampoule with a unit of 1000, and then take 0. 1ml of this solution and add it to 0.9 ml of 0.9% sodium chloride injection to obtain 100 unit /ml.

10.2 skin test method and observation results:

Take 0. 1 ml (10 unit) of skin test solution for intradermal injection. The result is the same as that of penicillin skin test. This drug should not be used in patients with positive reaction.

10.3 Note:

1. Different pharmaceutical factories and batches have different product purity and allergic reaction.

2. People with allergic history should be very careful or not.

1 1 thymosin injection

The original drug was made into a solution of 25ug/ml and injected intradermally with 0. 1ml. Those who are positive are forbidden to enter.

12 fluorescein sodium injection

Before intravenous administration, inject 5ml of this product 1% solution intravenously, and conduct an allergy test10-15min. If there is no response, push it all out. After injecting and taking this product for several hours, the patient's reaction should be closely observed.

Second, the provisions and warnings about skin test in the drug instructions

Table 1 Provisions on skin test in drug instructions

Trade names, generic names, and warnings from dosage manufacturers.

Penicillin sodium for injection 654.38+0.6 million U Huabei Pharmaceutical Co., Ltd. must carry out penicillin skin test before applying this product, and those who are positive are prohibited.

Piperacillin sodium 2g Qilu Pharmaceutical Factory for Injection must carry out penicillin skin test first, and those who are positive are prohibited.

Piperacillin sodium/tazobactam sodium for injection (4.5g) is prohibited for patients with allergic history to any β -lactam drugs or β -lactamase inhibitors produced by Lida Piperacillin Company. Before use, you should carefully ask yourself about your allergic history to cephalosporins, penicillins and other antigens. Once allergic reaction occurs, stop taking the medicine immediately.

Bangda injection piperacillin sodium/tazobactam sodium 1. 1.25g Qilu Pharmaceutical Factory is prohibited for patients with allergic history to cephalosporins, penicillins or β -lactamase inhibitors. The allergic history of cephalosporins, penicillins and β -lactamase inhibitors should be carefully inquired before use. Once allergic reaction occurs, stop taking the medicine immediately.

Liyang mezlocillin sodium for injection 1g Shandong Ruiyang Pharmaceutical Co., Ltd. is prohibited for those who are allergic to penicillin antibiotics. Penicillin skin test must be done before medication, and those who are positive are prohibited.

You Lixin injection 0.75g ampicillin sodium sulbactam sodium Pfizer Pharmaceutical Co., Ltd. needs to do penicillin sodium intradermal sensitivity test before use, and it is forbidden for those who are positive.

Ampicillin sodium and sulbactam sodium for injection1.50g.

(2: 1) North China Pharmaceutical Group Beiyuan Co., Ltd. banned those allergic to penicillin antibiotics; Penicillin skin test must be done before medication, and those who are positive are prohibited; Cross allergic reaction: people who are allergic to one penicillin antibiotic may also be allergic to other penicillin antibiotics, and may also be allergic to penicillamine or cephalosporins;

Amoxicillin sodium and clavulanate potassium for injection1.2g.

(1: 0.2) North China Pharmaceutical Co., Ltd. must conduct penicillin skin test first.

Ticarcillin sodium and clavulanate potassium 3.2g for Timetine injection.

(3: 0.2) The sensitivity test of β -lactam antibiotics (such as penicillin and cephalosporin) should be carried out before using Timetin.

Cefradine 1g Squibb for Fanjiefu injection is prohibited for those who are allergic to cephalosporins. Cephalosporins and penicillins are partially cross-allergic, so those who are allergic to penicillin should use them with caution.

Cefuroxime sodium for injection 0.75g GlaxoSmithKline is prohibited for those who are allergic to cephalosporins. Although cross reactions have been reported, patients who are allergic to penicillin can generally use cephalosporins safely, but special attention should be paid.

Cefuroxime sodium for injection 1.5g Shenzhen Jiuxin Pharmaceutical Co., Ltd. is prohibited for those who are allergic to cephalosporins; People who are allergic to penicillins should use this product with caution.

Xinfuxin Cefuroxime Sodium 0.5g Guangzhou Tianxin Pharmaceutical Co., Ltd. is prohibited for those who are allergic to this product and cephalosporins. Those who are allergic to penicillin weigh the advantages and disadvantages, and those who have allergic shock or immediate reaction to penicillin should not choose cephalosporin.

Hailing Pharmaceutical Factory of Hainan Province prohibits the use of lorazepam sodium for injection for those who have a history of allergic to this product and cephalosporins. Those who are allergic to penicillin should use it with caution.

Cefotaxime sodium 1g is used for Kefulong injection, but it is strictly prohibited for patients with a history of rapid allergic reaction to cephalosporins.

Rorschach ceftriaxone sodium 1g for injection is prohibited in patients who are allergic to cephalosporins. Like other cephalosporins, although the patient's complete medical history has been obtained, the possibility of anaphylactic shock cannot be ruled out, and anaphylactic shock needs urgent treatment.

Ceftriaxone sodium 1g is used for patients with Panthera Shufu injection who are allergic to penicillin. Taiwan Province Panthera Pharmaceutical Factory may also be allergic to this product. This product should not be used for patients who are allergic to pantothenic acid.

Fordaxin ceftazidime 1g GlaxoSmithKline for injection is prohibited for those who are allergic to cephalosporins.

Before use, you should carefully ask yourself about your allergic history to ceftazidime, cephalosporin and penicillin. Special attention should be paid to patients with allergic reactions to penicillin or β -lactam antibiotics. Ceftazidime should only be used in patients with type I or immediate allergy to penicillin, and special preventive measures should be taken.

Ceftazidime 1g of Kaifuding injection is prohibited for patients who are allergic to Kaifuding and cephalosporins. Before using this product, the patient should be asked in detail whether he is allergic to cephalosporins, penicillins or other drugs. Carvedilol should be used with caution if the patient is allergic to penicillin.

Ceftazidime for injection 1g Qilu Pharmaceutical Factory is prohibited for patients with cephalosporin allergy. Those who are allergic to penicillin weigh the advantages and disadvantages, and those who have allergic shock or immediate reaction to penicillin should not choose cephalosporin.

Cefoperazone sodium for injection 1g Taiyang Pharmaceutical is allergic to cephalosporin, and cefoperazone sodium is prohibited. Before using this product, the patient should be asked in detail whether he is allergic to cephalosporins, penicillins or other drugs. If the patient is allergic to penicillin, cefoperazone sodium should be used with caution. Patients with allergic history, especially those who are allergic to drugs, should be especially careful when using antibiotics.

Those who are allergic to this product or its components or cephalosporin antibiotics are forbidden to use cefminox sodium1g for Meishiling injection of Meiji Fruit Co., Ltd. in Japan; If you have an allergic history to this product or its components or cephalosporins, it is recommended to disable it and use it with caution if necessary.

0.5g of cefoperazone sodium and sulbactam sodium for injection is Lily of the Valley injection, which is prohibited by Harbin Pharmaceutical Group Pharmaceutical Factory for patients who are allergic to this product or cephalosporins. Use with caution in patients who are allergic to penicillin antibiotics.

Cefoperazone sodium and sulbactam sodium 1g for Shupushen injection.

(1: 1) Pfizer Pharmaceutical Co., Ltd. is known to be banned for those who are allergic to cephalosporins such as penicillins, sulbactam and cefoperazone.

1. cefoperazone sodium and sulbactam sodium 5g for new reserpine injection.

(2: 1) Likang Pharmaceutical Co., Ltd. in Zhuhai Special Economic Zone banned people who are allergic to penicillin or cephalosporins.

Cefoperazone sodium and sulbactam sodium for injection 4g This product of Shenyang China Medical University Pharmaceutical Co., Ltd. or patients with cephalosporin allergy are prohibited; Use with caution in patients who are allergic to penicillin antibiotics.

Maspin Cefepime Hydrochloride 1 g Squibb is contraindicated in patients who are allergic to this product, L-arginine, cephalosporin, penicillin or other β -lactam antibiotics.

Imipenem cilastatin sodium 0.5g Merck for Tylenol Injection is contraindicated in patients who are allergic to this product. Use with caution those who are allergic to β -lactam antibiotics.

Shenzhen Haibin Pharmaceutical Co., Ltd. prohibits people who are allergic to this product and other carbapenem antibiotics from using Meropenem 0.5g for injection. Patients who are allergic to penicillin or other β -lactam antibiotics are also allergic to this product, so use it with caution.

Sumitomo Pharmaceutical Co., Ltd. prohibits the use of meropenem 0.5g for injection for those who are allergic to the ingredients of this product and other carbapenem antibiotics. Careful use of β -lactam antibiotics may lead to anaphylactic shock. Ask about allergy history before use.

0.5g aztreonam axetil Squibb is prohibited if there is a history of allergy to aztreonam or L- arginine. Use with caution those who are allergic or allergic to β -lactam antibiotics.

Thymosin injection 40mg The biochemical factory of Bethune Medical University Pharmaceutical Factory should do intradermal allergy test for allergic people before injection or after termination of treatment.

Thymosin for injection 10 mg Beijing Sihuan Kebao Pharmaceutical Co., Ltd. For people with allergic constitution, intradermal allergy test must be done before injection or after termination of treatment.

Heshan thymosin injection should be used with caution for people with thymosin allergy.

Fluorescein sodium injection 0.3g Guangzhou Star Pharmaceutical Co., Ltd. A few patients may have allergic reactions to this product. An allergy test is recommended.

Third, summary.

1 The drugs that can be used for the skin test of penicillin skin test agent are: penicillin sodium for injection, piperacillin sodium for injection, mezlocillin sodium for injection, ampicillin sodium and sulbactam sodium for injection, amoxicillin sodium and clavulanate potassium for injection.

Cephalosporins that are allergic to penicillin and banned include: Shupushen, Xinrui Puxin and Maspin;

3 For those allergic to penicillin, other cephalosporins and carbapenems should be used with caution;

Pharmacopoeia clearly stipulates that skin test should be carried out before using penicillin drugs, and those who are allergic are prohibited; Patients who are allergic to penicillin should weigh the advantages and disadvantages according to their illness and use cephalosporins. Those who have allergic shock or immediate reaction to penicillin should not choose cephalosporin again.

5 Pharmacopoeia stipulates that thiamethoxam (aztreonam) is prohibited for other β -lactams that have had immediate reactions such as anaphylactic shock;

6 Pharmacopoeia stipulates that imipenem-cilastatin sodium (Tylenol) is prohibited for those who have severe systemic allergic reaction or anaphylactic shock to penicillin and cephalosporins.