Tuesday, January 30, 2007

Omnicef Side Effects

Hi,

My 2yr old daughter was prescribed Omnicef for Strep throat. This is day five and yesterday evening we started noticing a significant change in behavior. She's screaming and crying not wanting to take a bath and not wanting to go to bed (both unusual). She appears okay during the day. Could this excessive irritability be due to the Omnicef?

“? Side effect to Omnicef "

Dear “? Side effect to Omnicef”,

Irritability is not a side effect listed in the Physician’s Desk Reference as an adverse reaction to Omnicef. Omnicef is an antibiotic that is commonly prescribed in the pediatric population and I personally have never heard this complaint from any of my patients. The side effects that may occur in the pediatric population (> or = 1 %)include diarrhea, rash and vomiting. Other less frequent side effects(Less than 1%) include abdominal pain, vaginal yeast infection, vaginitis, upset stomach, rash, nausea and abnormal stools.(1)

Brick red colored stools is a side effect that occurs when Omnicef is taken with foods rich in iron or with iron supplements. The iron in the food binds with the Omnicef to form a nonabsorbable complex in the gastrointestinal tract. This nonabsorbable complex causes the stool to turn brick red in color.(1) I have seen this side effect in children taking Omnicef. The brick colored stools return to their normal color after the antibiotic course is finished. In order to prevent this change of stool color from occurring, iron supplements should not be giving within two hours of receiving Omnicef. Iron supplements can be given 2 hours before the Omnicef dosage or two hours after the dosage.

A two year old child typically does not have the cognitive ability or communication skills to decipher and communicate pain, abdominal discomfort, vaginal itchiness or nausea effectively. If your daughter’s irritability continues, these potential side effect to Omnicef should be considered as a possible cause. Irritability and crying at night can also represent another problem such as an ear infection or a behavioral issue. Therefore an evaluation by your Doctor may be necessary in order to decipher the cause of her symptoms.

Many children receive extra loving care when they are sick. During an illness, routines change and special privileges may be granted. For example a child may be allowed to stay up later at night or sleep in their parent’s bed when they are sick. They also tend to get more individual attention from their parents when they are not feeling well. When a child’s condition improves it is normal for them to find displeasure and misbehave when old routines are re-introduced.

If your daughter had a change in her bedtime routine when she was ill, there is always the possibility that she may be acting out because she doesn’t want to go back to the old routine. For example if she was allowed to sleep in your bed when she was sick, it would be expected that she would become upset when she was put in her bed alone.

If you feel this is the case, explain to your daughter that she was allowed to stay up late or sleep in mommy’s bed when she was sick but now that she’s better, she has to sleep in her own bed again. Be assured that children understand hundreds of words before they actually speak and she will understand what you are trying to tell her. At the same time it would be a good idea to emphasize what she can do now that she is feeing better; for example go to the store or visit with friends.

Lastly, I would like to mention that a Strep infection can develop complications. In most cases, once a child receives Antibiotics the infection is eradicated and the child does not experience any complications or long term effects. Although there is a possibility that a child can develop complications whether she is treated with an Antibiotic or not.(2,3) These potential complications include Otitis Media(middle ear infection), Sinusitis, peritonsillar abscess, Tonsillitis, Cervical Adenitis, Glomerulonephritis, Scarlet fever, Arthritis and Bacteremia (infection in the blood).(2,3)

Therefore a child diagnosed with a Strep infection that fails to show a positive response to Antibiotic therapy or a child who develops new symptoms shortly after being diagnosed with Strep needs to be re-evaluated by a Physician. Concerning signs include a persistent fever, inability to swallow, swelling in the neck area, shortness of breath, change in urinary pattern or rash.

I hope your daughter is feeling better soon.

If you are interested in reading other Pediatric Advice Stories covering topics discussed:

Strep Throat

Scarlatina

Scarlet Fever

Acute Otitis Media

Chronic Otitis Media

Cervical Adenitis

References:
(1) Physician’s Desk Reference. 2007. Montvale, NJ. Thomson PDR at Montvale.
(2)American Academy of Pediatrics. Group A Streptococcal infections. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:483-494.
(3)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1600-1602,1592,1686.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice- Your Questions Answered

No comments: