Q: If a patient in the operating room, intubated, is on or has been given steroids, is it safe to give a drug that the patient is allergic to? What should be done to make it safer?
— Dr. M, surgeon
Dear Dr. M
One first has to establish whether it is antibiotic “x” and none other will do. If that is the case, then the choice is to desensitize the patient giving increasing dosage while monitoring for side effects until the maximum dose is reached. From that point on the recommended therapeutic dosage can be given.
However, if the patient is in the hospital, intubated and pretreated with steroids and an antihistamine (with epinephrine and other meds at the ready) one can be much more aggressive. But be prepared for anaphylaxis and know how to handle it.
Alternatively, if another unrelated antibiotic will do the job, go that route.