abc 2020. godina vol 20 broj 3urgentnamedicina.sld.org.rs/dotasset/82240.pdfpodrazumeva rad u kome...

ABC 2020. godina vol 20 broj 3

Sadržaj /Contents Impresum/ Impressum

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Uređivačka politika/ Politics

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Originalni radovi / Original articles

Self-reported allergy to parenterally administered penicillin

Marta S Ljubisavljević1

Slavoljub R Živanović2

1Health care center "Milutin Ivković" Palilula, Belgrade 2City Institute Emergency medical service Belgrade Serbia

Samoprijavljene alergije na parenteralno dati penicilin

1Dom zdravlja "Milutin Ivković" Palilula, Beograd

2 Gradski zavod za hitnu medicinsku pomoć Beograd Srbija

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Uputstvo autorima Instruction for Autors

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Impressum

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ABC časopis urgentne medicine 2020;(1):a-e

Open Access

ABC Časopis urgentne medicine

ABC Journal of emergency medicine

Izdavač

Publisher

Sekcija Urgentne medicine Srpskog lekarskog društva

Section for Emergency Medicine of Serbian Medical Society

11000 Beograd, Džordža Vašingtona 19,

+ 381 (0)11 3234 261 [email protected]

Časopis izlazi tri puta godišnje april-avgust-decembar

Journal is publisted tree times a year april-august-december

Članci su u celini dostupni na

The articles are completely available at http://urgentnamedicina.sld.org.rs/sr/casopis/

Lektor za srpski jezik

Serbian language editor

Živka Stanojević

Grafička obrada i prelom

Slavoljub Živanović

Leyout & Prepress

Slavoljub Živanović

ABC časopis urgentne medicine je zvanična publikacija Sekcije Urgentne Medicine

Srpskog lekarskog društva

ABC Journal of emergency medicine is an official publication

of Section of Emergency Medicine of Serbian medical society

e-issn ISSN 2560-3922 (Online)

COBISS SR-ID UDC 105333260

mailto:[email protected]://urgentnamedicina.sld.org.rs/sr/casopis/

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Uređivački odbor

Editorial board

Glavni i odgovorni urednik

Prim dr Zagorka Maksimović MD Beograd Srbija

Editor in Chief

Zagorka Maksimović MD Primarius Belgrade Serbija

Primarijus, specijalista urgentne medicine. Recenzent časopisa OPŠTA MEDICINA i časopisa

HALO 194, stručnih i naučnih radova kandidata za dobijanje naziva Primarijus. Bila zamenik

predsednika Sekcije Urgentne medicine SLD-a. Bila je delegat u Regionalnoj lekarskoj komori

Beograd i Lekarskoj komori Srbije u dva saziva. Bila predsednik Posebnog odbora za medicinsku

etiku RLK Beograda.

Professional title of Primarius, Emergency medicine specialist. Reviewer for the medical journal

General Practice and HALO 194 journal. Reviewer of scientific papers for obtaining the

professional title of Primarius. Was vice President of the Emergency Medicine Section of Serbian

Medical Society. Was delegate of the Regional Medical Chamber Belgrade and Serbian Medical

Chamber. Was Chairman of the Special Committee on Medical Ethics of Regional Medical

Chamber of Belgrade.

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Članovi

Members

Momir Mikov Univerzitet u Novom Sadu, Medicinski fakultet, Srbija

Momir Mikov, University of Novi Sad, Faculty of Medicine, Serbia

Velibor Vasović Univerzitet u Novom Sadu, Medicinski fakultet, Srbija

Velibor Vasović, University of Novi Sad, Faculty of Medicine, Serbia

Lidija Ristić Univerzitet u Nišu, Medicinski fakultet, Srbija

Lidija Ristić, University of Niš, Faculty of Medicine, Serbia

Dragana Bogićević Univerzitet u Beogradu, Medicinski fakultet, Srbija

Dragana Bogićević, University of Belgrade, Faculty of Medicine, Serbia

Slađana Anđelić Gradski zavod za hitnu medicinsku pomoć Beograd, Srbija

Slađana Anđelić, City Institute for Emergency Medicine Belgrade, Serbia

Dragan Milojević Zavod za hitnu medicinsku pomoć Kragujevac, Srbija

Dragan Milojević, Institute for Emergency Medicine Kragujevac, Serbia

Vladimir Gajić Zavod za hitnu medicinsku pomoć Kragujevac, Srbija

Vladimir Gajić , Institute for Emergency Medicine Kragujevac, Serbia

Kornelija Jakšić- Horvat Služba za Hitnu medicinsku pomoć Subotica, Srbija

Kornelija Jakšić Horvat, Emergency Medical Service of Subotica, Serbia

Snežana Holcer Vukelić Opšta bolnica Sombor, Srbija

Snežana Holcer Vukelić, General Hospital Sombor, Serbia

Zoran Milanov Služba za Hitnu medicinsku pomoć Vrbas

Zoran Milanov, Emergency medical service Vrbas

Snežana Petrović Gradski zavod za hitnu medicinsku pomoć Beograd, Srbija

Snežana Petrović , City Institute for Emergency Medicine Belgrade, Serbia Aleksandra Lučić Prokin Univerzitet u Novom Sadu, Medicinski fakultet, Srbija Aleksandra Lučić Prokin University of Novi Sad, Faculty of Medicine, Serbia

Slavoljub Živanović Gradski zavod za hitnu medicinsku pomoć Beograd, Srbija

Slavoljub Živanović , City Institute for Emergency Medicine Belgrade, Serbia

Mihaela Budimski Služba Hitne medicinske pomoći Subotica, Srbija

Mihaela Budimski, MD Emergency Medical Service of Subotica, Serbia

Nikola Beljić Opšta bolnica "Laza Lazarević" Šabac, Srbija

Nikola Beljić, General Hospital “Laza Lazarević” Šabac, Serbia

Međunarodni uređivački odbor

International editorial board

Viktor Švigelj Klinički centar Ljubljana, Slovenija

Viktor Švigelj University Medical Centre of Ljubljana, Slovenia Nada Banjac Univerzitet u Banjoj Luci, Medicinski fakultet, BIH Nada Banjac, University of Banja Luka, Faculty of Medicine,

Federation of B&H

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RECENZENTI: REVIEWERS

Prof.dr Lidija Ristić, Univerzitet u Nišu, Medicinski fakultet, Srbija

Prof.dr Lidija Ristić, University of Niš, Faculty of Medicine, Serbia

Doc. dr Aleksandra Lučić Prokin, Univerzitet u Novom Sadu, Medicinski fakultet, Srbija Doc.dr Aleksandra Lučić Prokin ,University of Novi Sad, Faculty of Medicine, Serbia

Prof.dr Branislav Milovanović, Univerzitet u Beogradu, Medicinski fakultet,

Srbija

Prof.dr Branislav Milovanović, University of Belgrade, Faculty of Medicine,

Serbia Prof. dr Velibor Vasović, Univerzitet u Novom Sadu, Medicinski fakultet, Srbija

Prof.dr Velibir Vasović, University of Novi Sad, Faculty of Medicine, Serbia

Doc.dr Dragana Bogićević, Univerzitet u Beogradu, Medicinski fakultet, Srbija

Doc.dr Dragana Bogićević, University of Belgrade, Faculty of Medicine, Serbia

Prof. dr Nada Banjac Univerzitet u Banjoj Luci, Medicinski fakultet, BIH Prof.dr Nada Banjac, University of Banja Luka, Faculty of Medicine, Federation of B&H

Van.prof. NS.dr sci.med Slađana Anđelić Gradski zavod za hitnu medicinsku pomoć Beograd,

Srbija

Van.prof. NS. dr sci.med Slađana Anđelić, City Institute for Emergency Medicine Belgrade,

Serbia

Doc. dr sci. med Vladimir Gajić Zavod za hitnu medicinsku pomoć Kragujevac, Srbija

Doc.dr sci.med Vladimir Gajić, City Institute for Emergency Medicine Kragujevac, Serbia

Doc. Dr sci. med Dragan Milojević Zavod za hitnu medicinsku pomoć Kragujevac, Srbija

Doc. dr sci.med Dragan Milojević, City Institute for Emergency Medicine Kragujevac, Serbia

Prim. mr sci. med Siniša Saravolac Zavod za hitnu medicinsku pomoć Novi Sad, Srbija

Prim.mr sci.med Siniša Saravolac, City Institute for Emergency Medicine Novi Sad, Serbia

Prim. dr Zagorka Maksimović Gradski zavod za hitnu medicinsku pomoć Beograd, Srbija

Prim.dr Zagorka Maksimović, City Institute for Emergency Medicine Belgrade, Serbia

Prim. dr Milan Božina Hitna medicinska pomoć Sombor, Srbija

Prim.dr Milan Božina, Emergency Medical Service of Sombor, Serbia

Prim. dr Milan Božina Hitna medicinska pomoć Sombor, Srbija

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Prim. dr Kornelija Jakšić Horvat Hitna medicinska pomoć Subotica, Srbija

Prim.dr Kornelija Jakšić Horvat, Emergency Medical Service of Subotica, Serbia

Prim. dr Snežana Holcer Vukelić Hiitna medicinska pomoć Sombor, Srbija

Prim.dr Snežana Holcer Vukelić, Emergency Medical Service of Sombor, Serbia

Prim. dr Slavoljub Živanović subspec. gerontologije Gradski zavod za hitnu medicinsku pomoć

Beograd, Srbija

Slavoljub Živanović MD primarius subspec. Gerontologist City Institute for Emergency

Medicine Belgrade, Serbia

Impressum

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I

Politika časopisa

ABC časopis urgentne medicine je časopis

posvećen radovima iz oblasti prehospitalne

medicine ili inicijalno boničkog nivoa,

isključivo originalne, prethodno

neobjavljene radove:

Tipovi radova koji se objavljuju u

časopisu

Originalni naučni (stručni) rad ili prikaz

slučaja (pod originalnim naučnim radom se

podrazumeva rad u kome se prvi put

objavljuju rezultati sopstvenih istraživanja).

Pregledni rad koji sadrži originalan,

detaljan i kritički prikaz istraživačkog

problema ili područja u kome je autor već

ostvario određeni doprinos, prikazan u vidu

autocitata.

Kratko ili prethodno saopštenje, što

podrazumeva originalan naučni rad punog

formata, ali manjeg obima.

Naučna kritika, odnosno polemika na

određenu temu zasnovana na naučnoj

argumentaciji, aktuelne teme: savremena

pitanja od teorijskog i praktičnog značja za

struku.

Monografske studije, istorijsko-arhivske,

leksiokografske, bibliografske studije ili

preglede podataka, za koje važi pravilo da

su u pitanju sažeti podaci koji ranije nisu bili

dostupni javnosti.

Ukoliko je rad deo magistarske teze,

odnosno doktorske disertacije, ili je urađen

u okviru naučnog projekta, to treba posebno

naznačiti u napomeni na kraju teksta.

Takođe, ukoliko je rad prethodno

saopšten na nekom stručnom sastanku,

navesti zvaničan naziv skupa, mesto i

vreme.

Recenzentski postupak

Recenzenti

ABC časopis urgentne medicine

primenjuje postupak dvostranog anonimnog

recenziranja svih radova. Svaki rukopis

recenziraju najmanje dva recenzenta.

Recenzenti deluju nezavisno jedni od

drugih, a njihov identitet je međusobno

nepoznat. Recenzenti se biraju isključivo

prema tome da li raspolažu odgovarajućim

znanjima za ocenu rukopisa. Ne smeju biti

iz iste institucije kao autori rukopisa niti

njihovi koautori u skorijoj prošlosti. Even-

tualni predlozi poimeničnih recenzenata od

strane autora rukopisa se ne uvažavaju.

Cilj recenzije jeste da Uredništvu pomogne

u donošenju odluke o tome da li rad treba

prihvatiti ili odbiti. Cilj je, takođe, da se u

procesu komunikacije s urednikom, autori-

ma i drugim recenzentima poboljša kvalitet

rukopisa.

Recenzentski proces

Rukopisi se upućuju na recenziju tek nakon

inicijalne ocene da li su, s obzirom na for-

mu i tematski delokrug, podobni za objavl-

jivanje u časopisu. Posebna pažnja se pos-

većuje tome da inicijalna ocena ne traje

duže nego što je neophodno.

U redovnim okolnostima postupak recenzi-

ranja traje najviše četiri nedelje, a samo izu-

zetno do tri meseca. Period od prijema rada

do njegovog objavljivanja traje u proseku

90 dana.

Tokom postupka recenzije glavni urednik

može da zahteva od autora da dostave

dodatne informacije, uključujući i primarne

podatke, ako su one neophodne za

donošenje suda o rukopisu. Urednik i

recenzenti moraju da čuvaju takve

informacije kao poverljive i ne smeju ih

upotrebiti u druge svrhe.

Razrešavanje nesaglasnosti

U slučaju da autori imaju ozbiljne i

osnovane zamerke na račun recenzije,

Uredništvo proverava da li je recenzija

objektivna i da li zadovoljava akademske

standarde. Ako se pojavi sumnja u

objektivnost ili kvalitet recenzije, urednik

angažuje dodatne recenzente.

Dodatni recenzenti se angažuju i u slučaju

kada su odluke recenzenata (odbiti/

prihvatiti) međusobno oprečne ili na drugi

Politika časopisa / Politics

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II

način nepomirljive.

Konačnu odluku o prihvatanju rukopisa za

objavljivanje donosi isključivo glavni

urednik.

Odgovornosti

Odgovornost autora

Autori garantuju da rukopis predstavlja

njihov originalan doprinos, da nije objavljen

ranije i da se ne razmatra za objavljivanje na

drugom mestu. Istovremeno predavanje

istog rukopisa u više časopisa predstavlja

kršenje etičkih standarda, što ga isključuje iz

daljeg razmatranja za objavljivanje u

časopisu. Rad koji je već objavljen na

nekom drugom mestu, ne može biti

preštampan u ABC časopisu urgentne

medicine. Autori snose svu odgovornost za

celokupan sadržaj rukopisa. Rukopis ne sme

da sadrži neosnovane ili nezakonite tvrdnje,

niti da krši prava drugih lica.

Autori su dužni da obezbede da njihov

autorski tim, naveden u rukopisu, obuhvati

sva i samo ona lica koja su značajno

doprinela sadržaju rukopisa. Ako su u

bitnim aspektima istraživačkog projekta i

pripreme rukopisa učestvovala i druga lica,

njihov doprinos treba navesti u fusnoti ili

posebnoj napomeni (Zahvalnica,

Acknowledgements).

Obaveza je autora da u napomeni navedu

naziv i kodnu oznaku naučno-istraživačkog

projekta u okviru koga je rad nastao, kao i

pun naziv Institucije koja je finansirala

projekat. U slučaju da je rad pod istim ili

sličnim naslovom bio izložen na nekom

skupu u vidu usmenog saopštenja, detalji o

tome treba da budu navedeni na istom

mestu.

Autori su dužni da potpuno i pravilno

citiraju izvore koji su značajno uticali na

sadržaj istraživanja i rukopisa. Delovi

rukopisa, uključujući tekst, jednačine, slike

ili tabele, koji su doslovno preuzeti iz drugih

radova, moraju biti jasno označeni

posebnom napomenom, na primer, znacima

navoda s preciznom oznakom mesta

preuzimanja (broja stranice) ili, ako su

obimniji, navesti u zasebnom paragrafu.

Pune reference svih navoda u tekstu (citati)

moraju biti navedene u zasebnom odeljku

(Literatura ili Reference) i to na

jednoobrazan način, u skladu sa citatnim

stilom koji časopis koristi. U odeljku

Literatura navode se samo citirani, a ne i

ostali izvori upotrebljeni prilikom pripreme

rukopisa.

U slučaju da autori otkriju grešku u svom

radu nakon njegovog objavljivanja, dužni

su da momentalno o tome obaveste glavnog

urednika (ili izdavača) i da sarađuju na

tome da se rad povuče ili ispravi.

Obveza je autora da u rukopisu navedu da li

su u finansijskom ili bilo kom drugom

bitnom sukobu interesa, koji bi mogao da

utiče na njihove rezultate ili interpretaciju

rezultata.

Predavanjem rukopisa, autori se obavezuju

na poštovanje uređivačke politike časopisa

Odgovornost Uredništva

Glavni urednik časopisa donosi konačnu

odluku o tome koji će se rukopisi objaviti.

Odluke se donose isključivo na osnovu

vrednosti rukopisa. Moraju biti oslobođeni

rasnih, polnih/rodnih, verskih, etničkih ili

političkih predrasuda. Prilikom donošenja

odluke o objavljivanju, glavni urednik se

rukovodi uređivačkom politikom, vodeći

računa o zakonskim propisima koji se

odnose na klevetu, kršenja autorskih prava i

plagiranje.

Članovi Uredništva, uključujući glavnog

urednika, ne smeju biti u sukobu interesa u

vezi sa rukopisima koje razmatraju. Članovi

za koje se pretpostavi da bi neko mogao

smatrati da su u sukobu interes, ne

učestvuju u postupku odlučivanja o

određenom rukopisu.

Rukopisi se čuvaju kao poverljiv materijal.

Informacije i ideje sadržane u rukopisima

ne smeju se koristiti u lične svrhe bez

izričite pisane dozvole autora.


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III

Glavni urednik i članovi Uredništva su

dužni da preduzmu sve razumne mere da

autori/recenzenti ostanu anonimni tokom i

nakon procesa evaluacije u skladu s

procedurom u upotrebi.

Odgovornost recenzenata

Recenzenti su dužni da kvalifikovano i u

zadatim rokovima dostave uredniku ocenu

naučne, odnosno stručne vrednosti rukopisa.

Recenzent vodi posebnu brigu o stvarnom

doprinosu i originalnosti rukopisa.

Recenzija mora biti sasvim objektivna. Sud

recenzenata mora biti jasan i potkrepljen

argumentima.

Recenzenti ocenjuju rukopise u odnosu na

usklađenost sadržaja s profilom časopisa,

značaj i korisnost sadržaja, adekvatnost

primenjenih metoda, naučnu vrednost

sadržanih informacija, stil izlaganja i

opremljenost teksta. Recenzija ima

standardni format koji obuhvata ocene

pojedinih dimenzija rada, opštu ocenu i

zaključnu preporuku.

Recenzent ne sme biti u sukobu interesa sa

autorima ili finansijerom istraživanja.

Ukoliko takav sukob postoji, recenzent je

dužan da o tome pravovremeno obavesti

urednika. Recenzent ne prihvata na

recenziju radove izvan oblasti za koju se

smatra potpuno kompetentnim.

Recenzenti treba da upozore glavnog

urednika ako imaju osnovanu sumnju ili

saznanje o mogućim povredama etičkih

standarda od strane autora rukopisa. Takođe,

treba da prepoznaju odgovarajuće izvore

koji u radu nisu uzeti u obzir. Mogu da

preporuče citiranje određenih referenci, ali

ne i da zahtevaju citiranje radova

objavljenih u časopisu ABC časopis

urgentne medicine ili svojih radova ako za

to ne postoji opravdanje.

Od recenzenata se očekuje da svojim

sugestijama unaprede kvalitet rukopisa. Ako

ocene da rad zaslužuje objavljivanje uz

korekcije, dužni su da preciziraju način na

koji to može da se ostvari.

Rukopisi koji su poslati recenzentu moraju

se smatrati poverljivim dokumentima.

Recenzenti ne smeju da koriste materijal iz

rukopisa za svoja istraživanja bez izričite

pisane dozvole autora.

Etičnost publikovanja Razrešavanje neetičkih postupaka

Svaki pojedinac ili institucija mogu u bilo

kom trenutku da uredniku i/ili Uredništvu

prijave saznanja o kršenju etičkih standarda

i drugim nepravilnostima i da o tome

dostave verodostojne informacije/dokaze

radi pokretanja istrage. Postupak provere

iznetih dokaza odvija se na sledeći način:

-glavni urednik donosi odluku o pokretanju

istrage;

-tokom tog postupka svi dokazi se smatraju

poverljivim materijalom i predočavaju

samo onim licima koja su direktno

obuhvaćena slučajem;

-Licima za koje se predpostavlja da su

prekrsili eticke standarde pruža se prilika da

odgovore na iznete optužbe;

-ako se utvrdi da je zaista došlo do

nepravilnosti, ocenjuje se da li je reč o

manjem prekršaju ili grubom kršenju

etičkih standarda.

Manji prekršaji, bez posledica po integritet

rada i časopisa, na primer, kada je reč o

nerazumevanju ili pogrešnoj primeni

publicističkih standarda, razrešavaju se u

direktnoj komunikaciji s autorima i

recenzentima bez uključivanja trećih lica,

na neki od načina.:

-Autorima i/ili recenzentima se upućuje

pismo upozorenja;

-Objavljuje se ispravka rada, na primer, u

slučaju kada se sa spiska referenci izostave

izvori koji su u samom tekstu citirani na

propisan način;

-Objavljuje se greška (erratum), na primer,

ako se ispostavi da je greška nastala

omaškom Uredništva.

U slučaju grubog kršenja etičkih standarda,

glavni urednik / Uredništvo može da

preduzme različite mere:

Objavljuje saopštenje ili uvodnik u kom se

slučaj opisuje; službeno obaveštava

afilijativnu organizaciju autora/recenzenta;


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IV

povlači objavljeni rada na način opisan

pod Politika povlačenja;

Izriče zabranu objavljivanja u časopisu na

određeni vremenski period;

Predočava slučaj nadležnim organizacijama

i regulatornim telima radi preduzimanja

mera iz njihove nadležnosti.

Ove mere se mogu primenjivati pojedinačno

ili istovremeno. U procesu razrešavanja

slučaja po potrebi se konsultuju nadležne

ekspertske organizacije, tela ili pojedinci.

Prilikom razrešavanja etički spornih

postupaka, Uredništvo se rukovodi

smernicama Komiteta za etiku publikovanja

(COPE).

Sprečavanje plagijarizma

ABC časops urgentne medicine ne

objavljuje plagirane radove. Uredništvo

polazi od stava da je plagiranje, odnosno

preuzimanje tuđih ideja, reči ili drugih

oblika kreativnog doprinosa i njihovo

predstavljanje kao svojih, grubo kršenje

naučne i izdavačke etike. Plagiranje može

da uključuje i kršenje autorskih prava, što je

zakonom kažnjivo.

Plagiranje obuhvata:

doslovno (reč po reč) ili gotovo doslovno

preuzimanje ili smišljeno, radi prikrivanja

izvora, parafraziranje delova tekstova drugih

autora bez jasnog naznačavanja izvora, na

način opisan pod Odgovornosti autora;

kopiranje jednačina, podataka ili tabela iz

drugih dokumenata bez pravilnog

naznačavanja izvora i/ili bez dozvole

izvornog autora ili nosioca autorskog prava.

Rukopis u kome se utvrde jasne indicije pla-

gijarizma, biće automatski odbijen. U sluča-

ju da se plagijarizam otkrije u već objavlje-

nom radu, rad će biti opozvan (povučen) u

skladu sa procedurom opisanom

pod: Politika povlačenja .

Politika povlačenja

U slučaju kršenja prava izdavača, nosilaca

autorskih prava ili samih autora, objavlji-

vanja istog rukopisa u više časopisa, lažnog

autorstva, plagijata, manipulacije podacima

radi prevare ili bilo koje druge zloupotrebe,

objavljeni rad se mora opozvati.

Rad se može opozvati i da bi se ispravile

ozbiljne i brojne omaške koje nije moguće

obuhvatiti objavljivanjem ispravke. Opoziv

objavljuje glavni urednik / Uredništvo,

autor(i) ili obe strane sporazumno.

Opoziv ima oblik zasebnog rada koji se

prikazuje u sadržaju sveske i urednički

klasifikuje kao Opoziv ili Retrakcija. U

SCIndeksu kao matičnoj bazi punog teksta,

uspostavlja se dvosmerna veza (HTML link)

između originalnog rada i retrakcije.

Originalni rad se i dalje čuva u

neizmenjenom obliku, s tim da se vodenim

žigom na PDF dokumentu na svakoj

stranici označava da je članak povučen.

Opozivi se publikuju prema zahtevima

COPE-a razrađenim od strane CEON-a kao

izdavača baze u kojoj se časopis primarno

indeksira.

Otvoreni pristup Politika otvorenog pristupa

ABC časops urgentne medicine se izdaje je

u režimu tzv. otvorenog pristupa. Sav

njegov sadržaj dostupan je korisnicima

besplatno. Korisnici mogu da čitaju,

preuzimaju, kopiraju, distribuiraju,

štampaju, pretražuju puni tekst članaka, kao

i da uspostavljaju HTML linkove ka njima,

bez obaveze da za to traže saglasnost autora

ili izdavača.

Pravo da sadržaj koriste bez pisane

saglasnosti ne oslobađa korisnike obaveze

da citiraju sadržaj časopisa na način opisan

pod Licenciranje .

Arhiviranje digitalne verzije

Sve objavljene sveske časopisa arhiviraju se

po zakonu u digitalni depozit Narodne

biblioteke Srbije i istovremeno polažu u

Repozitorijum SCIndeksa - Srpskog

citatnog indeksa kao primarnu bazu punog

teksta.


——————————————————————


file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/ABC%20UM/ABC%20politika.doc#ppRP#ppRP#ppRP#ppRPhttp://publicationethics.org/resources/http://publicationethics.org/resources/file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/ABC%20UM/ABC%20politika.doc#ppAR#ppAR#ppAR#ppARfile:///C:/Documents%20and%20Settings/Administrator/My%20Documents/ABC%20UM/ABC%20politika.doc#ppRP#ppRP#ppRP#ppRPhttp://www.ceon.rs/pdf/postupanje_s_nelegitimnim_radovima.pdffile:///C:/Documents%20and%20Settings/Administrator/My%20Documents/ABC%20UM/ABC%20politika.doc#ppLC#ppLC#ppLC#ppLC

V

Naplata troškova autorima

ABC časops urgentne medicine ne naplaćuje

Article Submission Charge ni APC - Article

Processing Charge

Autorska prava i licenciranje Autorska prava

Autori zadržavaju autorska prava nad

objavljenim člancima, a izdavaču daju

neekskluzivno pravo da članak objavi, da u

slučaju daljeg korišćenja članka bude

naveden kao njegov prvi izdavač, kao i da

distribuira članak u svim oblicima i

medijima.

Licenciranje

Objavljeni članci distribuiraju se u skladu sa

licencom Creative Commons Autorstvo –

Deliti pod istim uslovima 4.0

International (CC BY-SA). Dopušteno je da

se delo kopira i distribuira u svim medijima

i formatima, da se prerađuje, menja i

nadograđuje u bilo koje svrhe, uključujući i

komercijalne, pod uslovom da se na pravilan

način citiraju njegovi prvobitni autori,

postavi veza ka originalnoj licenci, naznači

da li je delo izmenjeno i da se novo delo

objavi pod istom licencom kao i originalno.

Korisnici su pri tom dužni da navedu pun

bibliografski opis članka objavljenog u

ovom časopisu (autori, naslov rada, naslov

časopisa, volumen, sveska, paginacija), kao

i njegovu DOI oznaku. U slučaju

objavljivanja u elektronskoj formi, takođe su

dužni da postave HTML link kako sa

originalnim člankom objavljenim u časopisu

ABC časopis urgentne medicine, tako i sa

korišćenom licencom.

Autori mogu da stupaju u zasebne, ugovorne

aranžmane za neekskluzivnu distribuciju

rada objavljenog u časopisu (npr.

postavljanje u institucionalni repozitorijum

ili objavljivanje u knjizi), uz navođenje da je

rad prvobitno objavljen u ovom časopisu.

Politika samoarhiviranja

Autorima je dozvoljeno da objavljenu

verziju rada deponuju u institucionalni ili

tematski repozitorijum ili da je objave na

ličnim veb stranicama (uključujući i profile

na društvenim mrežama, kao što su

ResearchGate, Academia.edu, itd. na sajtu

institucije u kojoj su zaposleni, u bilo koje

vreme nakon objavljivanja u časopisu.

Autori su obavezni da pri tom navedu pun

bibliografski opis članka objavljenog u

ovom časopisu (autori, naslov rada, naslov

časopisa, volumen, sveska, paginacija) i

postave link kako na DOI oznaku tog

članka, tako i na korišćenu licencu.

Odricanje od odgovornosti

Stavovi izneti u objavljenim radovima ne

izražavaju stavove urednika i članova

Redakcije časopisa. Autori preuzimaju

pravnu i moralnu odgovornost za ideje

iznete u svojim radovima. Izdavač neće

snositi nikakvu odgovornost u slučaju

ispostavljanja bilo kakvih zahteva za

naknadu štete.


——————————————————————


https://creativecommons.org/licenses/by-sa/4.0/

VI

Politics:

ABC emergency medicine journal – Publication

policy ABC journal of emergency medicine publishes scientific

articles related to the medicine practiced in pre-hospital

environment and on initial hospital level, but strictly those

articles that haven’t already been printed or submitted for

publishing elsewhere.

Types of articles published in this journal

Original article or case report. The original article stands

for reports which present results of one’s original research

for the first time. Case report reveals individual cases from

medical practice and it usually describes one to three patients

or a family.

Review article – represents individual, well focused and

critical review of the research topic or field of expertise in

which the author has already made contribution, documented

through auto-citations

Short announcement should be full original article in a

short format.

Scientific review - systematic and critical assessment of a

certain scientific topic based on scientific arguments

Exceptionally with editor’s approval- monographic,

historical, bibliographic or lexicographic study, or

information review (these are supposed to summarize data

previously unavailable to public).

If the article is a part of a master’s theses or a part of a

dissertation, or it is made through a scientific project, it

should be emphasized in a reference at the end of the text.

Likewise, if an article has been presented at scientific

convention, precise information of the time, place and title of

the event should be noted.

Reviewing procedure

Peer reviewers

ABC emergency medicine journal uses double-blind

review system for all papers. Each manuscript is

reviewed by at least two reviewers. The reviewers act

independently and they are not aware of each other’s

identities. The reviewers are selected solely

according to whether they have the relevant expertise

for evaluating a manuscript. They must not be from

the same institution as the author(s) of the

manuscript, nor be their co-authors in the recent past.

No suggestions of individual reviewers by the author

(s) of the manuscript will be accepted.

The purpose of peer review is to assists the Editorial

Board in making decision of whether to accept or

reject a paper. The purpose is also to assist the

author in improving papers.

Peer review process

Manuscripts are sent for review only if they pass the

initial evaluation regarding their form and thematic

scope. A special care is taken that the initial

evaluation does not last more than necessary.

Under normal circumstances, the review process

takes up to four weeks, and only exceptionally up to

three months. The total period from the submission

of a manuscript until its publication takes an average

of 90 days.

During the review process the Editor-in-Chief may

require authors to provide additional information

(including raw data) if they are necessary for the

evaluation of the manuscript. These materials shall

be kept confidential and must not be used for any

other purposes.

Resolving inconsistences

In the case that the authors have serious and

reasonable objections to the reviews, the Editorial

Board makes an assessment of whether a review is

objective and whether it meets academic standards.

If there is a doubt about the objectivity or quality of

review, the Editor-in-Chief will assign additional

reviewer(s).

Additional reviewers may also be assigned when

reviewers’ decisions (accept or reject) are contrary

to each other or otherwise substantially

incompatible.

The final decision on the acceptance of the

manuscript for publication rests solely with the

Editor-in-Chief.

Responsibilities

Authors' responsibilities

Authors warrant that their manuscripts are their

original works, that they have not been published

before, and are not under consideration for

publication elsewhere. Parallel submission of the

same paper to another journal constitutes a

misconduct and eliminates the manuscript from

further consideration. The work that has already

been published elsewhere cannot be reprinted in the

ABC emergency medicine journal . Authors are

exclusively responsible for the contents of their


——————————————————————


VII

submissions. Authors affirm that the article contains

no unfounded or unlawful statements and does not

violate the rights of third parties.

Authors must make sure that their author team listed

in the manuscript includes all and only those authors

who have significantly contributed to the submitted

manuscript. If persons other than authors were

involved in important aspects of the research project

and the preparation of the manuscript, their

contribution should be acknowledged in a footnote or

the Acknowledgments section.

It is the responsibility of the authors to specify the

title and code label of the research project within

which the work was created, as well as the full title

of the funding institution. In case a submitted

manuscript has been presented at a conference in the

form of an oral presentation (under the same or

similar title), detailed information about the

conference shall be provided in the same place.

Authors are required to properly cite sources that

have significantly influenced their research and their

manuscript. Parts of the manuscript, including text,

equations, pictures and tables that are taken verbatim

from other works must be clearly marked, e.g. by

quotation marks accompanied by their location in the

original document (page number), or, if more

extensive, given in a separate paragraph.

Full references of each quotation (in-text citation)

must be listed in the separate section (Literature or

References) in a uniform manner, according to the

citation style used by the journal. References section

should list only quoted/cited, and not all sources used

for the preparation of a manuscript.

When authors discover a significant error or

inaccuracy in their own published work, it is their

obligation to promptly notify the Editor-in-Chief (or

publisher) and cooperate with him/her to retract or

correct the paper.

Authors should disclose in their manuscript any

financial or other substantive conflict of interest that

might have influenced the presented results or their

interpretation.

By submitting a manuscript the authors agree to

abide by the Editorial Policies of ABC emergency

medicine journal .

Editorial responsibilities

The Editor-in-Chief is responsible for deciding

which articles submitted to the journal will be

published. The decisions are made based exclusively

on the manuscript's merit. They must be free from

any racial, gender, sexual, religious, ethnic, or

political bias. When making decisions the Editor-in-

Chief is also guided by the editorial policy and legal

provisions relating to defamation, copyright

infringement and plagiarism.

Members of the Editorial Board including the Editor

-in-Chief must hold no conflict of interest with

regard to the articles they consider for publication.

Members who feel they might be perceived as being

involved in such a conflict do not participate in the

decision process for a particular manuscript.

The information and ideas presented in submitted

manuscripts shall be kept confidential. Information

and ideas contained in unpublished materials must

not be used for personal gain without the written

consent of the authors.

Editors and the editorial staff shall take all

reasonable measures to ensure that the authors/

reviewers remain anonymous during and after the

evaluation process in accordance with the type of

reviewing in use.

Reviewers' responsibilities

Reviewers are required to provide the qualified and

timely assessment of the scholarly merits of the

manuscript. The reviewer takes special care of the

real contribution and originality of the manuscript.

The review must be fully objective. The judgment of

the reviewers must be clear and substantiated by

arguments.

The reviewers assess manuscript for the compliance

with the profile of the journal, the relevance of the

investigated topic and applied methods, the scientific

relevance of information presented in the

manuscript, the presentation style and scholarly

apparatus. The review has a standard format.

The reviewer must not be in a conflict of interest

with the authors or funders of research. If such a

conflict exists, the reviewer is obliged to promptly

notify the Editor-in-Chief. The reviewer shall not

accept for reviewing papers beyond the field of his/

her full competence.


——————————————————————


VIII

Reviewers should alert the Editor-in-Chief to any

well-founded suspicions or the knowledge of

possible violations of ethical standards by the

authors. Reviewers should recognize relevant

published works that have not been considered in the

manuscript. They may recommend specific

references for citation, but shall not require to cite

papers published in ABC emergency medicine

journal , or their own papers, unless it is justified.

The reviewers are expected to improve the quality of

the manuscript through their suggestions. If they

recommend correction of the manuscript prior to

publication, they are obliged to specify the manner in

which this can be achieved.

Any manuscripts received for review must be treated

as confidential documents. Reviewers must not use

unpublished materials disclosed in submitted

manuscripts without the express written consent of

the authors.

Ethical publishing

Dealing with unethical behaviour

Anyone may inform the Editor-in-Chief / Editorial

Board at any time of suspected unethical behaviour

or any type of misconduct by giving the necessary

credible information/evidence to start an

investigation.

o Editor-in-Chief makes the decision regarding

the initiation of an investigation.

o During an investigation, any evidence should

be treated as confidential and only made available to

those strictly involved in the process.

o The accused will always be given the chance

to respond to any charges made against them.

o If it is judged at the end of the investigation

that misconduct has occurred, then it will be

classified as either minor or serious.

Minor misconduct (with no influence on the integrity

of the paper and the journal, for example, when it

comes to misunderstanding or wrong application of

publishing standards) will be dealt directly with

authors and reviewers without involving any other

parties. Outcomes include:

o Sending a warning letter to authors and/or

reviewers.

o Publishing correction of a paper, e.g. when

sources properly quoted in the text are omitted from

the reference list.

o Publishing an erratum, e.g. if the error was

made by editorial staff.

In the case of major misconduct the Editor-in-Chief /

Editorial Board may adopt different measures:

o Publication of a formal announcement or

editorial describing the misconduct.

o Informing officially the author's/reviewer's

affiliating institution.

o The formal, announced retraction of

publications from the journal in accordance with the

Retraction Policy .

o A ban on submissions from an individual for

a defined period.

o Referring a case to a professional

organization or legal authority for further

investigation and action.

The above actions may be taken separately or

jointly. If necessary, in the process of resolving the

case relevant expert organizations, bodies, or

individuals may be consulted.

When dealing with unethical behaviour, the Editorial

Board will rely on the guidelines and

recommendations provided by the Committee on

Publication Ethics (COPE).

Plagiarism prevention

ABC emergency medicine journal does not publish

plagiarised papers. The Editorial Board has adopted

the stance that plagiarism, where someone assumes

another's ideas, words, or other creative expression

as one's own, is a clear violation of scientific ethics.

Plagiarism may also involve a violation of copyright

law, punishable by legal action.

Plagiarism includes the following:

o Verbatim (word for word), or almost

verbatim copying, or purposely paraphrasing

portions of another author's work without clearly

indicating the source or marking the copied fragment

(for example, using quotation marks) in a way

described under Authors’ responsibilities ;

o Copying equations, figures or tables from


——————————————————————


IX

someone else's paper without properly citing the

source and/or without permission from the original

author or the copyright holder.

Any manuscript which shows obvious signs of

plagiarism will be automatically rejected. In case

plagiarism is discovered in a paper that has already

been published by the journal, it will be retracted in

accordance with the procedure described under

Retraction policy .

Retraction policy

Legal limitations of the publisher, copyright holder

or author(s), infringements of professional ethical

codes, such as multiple submissions, bogus claims of

authorship, plagiarism, fraudulent use of data or any

major misconduct require retraction of an article.

Occasionally a retraction can be used to correct

numerous serious errors, which cannot be covered by

publishing corrections. A retraction may be published

by the Editor-in-Chief / Editorial Board, the author

(s), or both parties consensually.

The retraction takes the form of a separate item listed

in the contents and labeled as "Retraction". In

SCIndeks, as the journals' primary full-text database,

a two-way communication (HTML link) between the

original work and the retraction is established. The

original article is retained unchanged, except for a

watermark on the PDF indicating on each page that it

is “retracted”.

Retractions are published according to the

requirements of COPE operationalized by CEON/

CEES as the journal indexer and aggregator.

Open access

Open access policy

ABC emergency medicine journal is published under

an Open Access licence. All its content is available

free of charge. Users can read, download, copy,

distribute, print, search the full text of articles, as

well as to establish HTML links to them, without

having to seek the consent of the author or publisher.

The right to use content without consent does not

release the users from the obligation to give the credit

to the journal and its content in a manner described

under Licensing .

Archiving digital version

In accordance with law, digital copies of all

published volumes are archived in the legal deposit

library of the National Library of Serbia and

concurrently in the Repository of SCIndeks - The

Serbian Citation Index as the primary full text

database.

The journal does not charge Article Submission

Charge nor Article Processing Charge.

Copyright & Licensing

Copyright

Authors retain copyright of the published papers and

grant to the publisher the non-exclusive right to

publish the article, to be cited as its original

publisher in case of reuse, and to distribute it in all

forms and media.

Licensing

The published articles will be distributed under the

Creative Commons Attribution ShareAlike 4.0

International license (CC BY-SA) . It is allowed to

copy and redistribute the material in any medium or

format, and remix, transform, and build upon it for

any purpose, even commercially, as long as

appropriate credit is given to the original author(s), a

link to the license is provided, it is indicated if

changes were made and the new work is distributed

under the same license as the original.

Users are required to provide full bibliographic

description of the original publication (authors,

article title, journal title, volume, issue, pages), as

well as its DOI code. In electronic publishing, users

are also required to link the content with both the

original article published in ABC emergency

medicine journal and the licence used.

Authors are able to enter into separate, additional

contractual arrangements for the non-exclusive

distribution of the journal's published version of the

work (e.g., post it to an institutional repository or

publish it in a book), with an acknowledgement of

its initial publication in this journal.

Self-archiving policy

Authors are permitted to publisher's version (PDF)

of their work in an institutional repository, subject-

based repository, author's personal website

(including social networking sites, such as


——————————————————————


X

ResearchGate, Academia.edu, etc.), and/or

departmental website at any time after publication.

Full bibliographic information (authors, article title,

journal title, volume, issue, pages) about the original

publication must be provided and links must be made

to the article's DOI and the license.

Disclaimer

The views expressed in the published works do not

express the views of the Editors and the Editorial

Staff. The authors take legal and moral responsibility

for the ideas expressed in the articles. Publisher shall

have no liability in the event of issuance of any

claims for damages. The Publisher will not be held

legally responsible should there be any claims for

compensation.


——————————————————————


Originalni radovi/Original Articles DOI: 10.5937/abc2003043L ———————————————————————————————————————————————————————————————————————————————————-

ABC časopis urgentne medicine 2020;20:(3):43-53 UDK 615.33.06:616-056.3 COBISS.SR-ID 28443145

Creative Commons Licence CCL (CC BY-SA)

Korespondencija /Correspondence to Slavoljub Živanović [email protected]

43



1Health care center "Milutin

Ivković" Palilula, Beograd

2City Institute Emergency

medical service Belgrade

Serbia

Self-reported allergy to parenterally administered penicillin

Summary

Introduction: Penicillin and penicillin products are in use in

everyday medical practice. The most frequently reported ad-

verse drug reactions are those to penicillin. New penicillin al-

lergies occur more often with parenteral than oral treatment. In

patients who are allergic to penicillin, prescribed therapy is

more often the one of antibiotics of broad spectrum, and this

therapy is more expensive. The allergies to penicillin are im-

munologically mediated.

Scope of Study: to present patients’ self-reported allergy to

penicillin and report on types of adverse reactions following

the parenteral administration of penicillin.

Methodology: Retrospective study of the work of one physi-

cian in the City Institute for EMS Belgrade in the period from

2017 to 2018 involving 2481 patients.

Results : There were 242 patients who reported they were al-

lergic to penicillin, of which 160 were able to explain what

happened after they were given parenteral penicillin. The co-

hort group was between 18-85 years old, average age 49.64 ±

17.24, while 65% of them were females. Most frequently re-

ported adverse reactions were rash, redness and itching of the

skin, loss of consciousness, swelling of the face, mouth, arms

or body in general. Serious reactions have been reported in

about 40% of cases.

Conclusion: There is a large percentage of self-reported aller-

gies to penicillin, and only a small number of those who ex-

perienced serious adverse reactions: swelling, unconsciousness,

coma or shock.

Key words: Primary health care, penicillin allergy, parenteral

penicillin, parenteral administration, emergency medical ser-

vice

https://creativecommons.org/licenses/by-sa/4.0/

Marta S Ljubisavljević, Slavoljub R Živanović. Self-reported allergy to parenterally administered penicillin

ABC časopis urgentne medicine 2020;20:(3):43-53

44

Introduction:

Penicillin and penicillin products are

in use in everyday medical practice. The

most frequently reported adverse drug reac-

tions are those to penicillin(1).

When patient states that he is allergic to

penicillin, this means that in his therapy we

cannot include drugs from this group be-

cause the patient would be placed under

health risks and this could endanger his life.

In such cases, the use of cephalosporins is

also questionable because of cross-

reactivity. Cross-reactivity exists between

penicillin and the first generation of cepha-

losporins, with a risk of 0.5%, but there is

no evidence of cross-reactivity for most

cephalosporins of the second and third gen-

eration(2,3). Depending on the research, in

subjects with a documented IgE-mediated

hypersensitivity to penicillin, a rate of posi-

tive responses to allergy tests with cepha-

losporins ranging from 0% to 27% have

been found(4). “Penicillin allergy is often

diagnosed early in life, and the history of

penicillin allergy persists in a patient's medi-

cal record for many years without verifica-

tion. Some physicians' consideration of a

patient having penicillin allergy is based on

patient experience that may have occurred

early in childhood"(5). Penicillin allergy

remains the most common drug allergy re-

ported, with a prevalence of ∼8–12% de-

pending on the specific population evalu-

ated, and in the USA there is a reported

prevalence of 10%(6). In the research con-

ducted in Boston, USA, " 35.5% of patients

had at least one reported drug allergy with

an average of 1.95 drug allergies per patient.

The most commonly reported drug allergies

in this population were to penicillin

(12.8%)”(7). Allergic reactions to penicillin

occur in about 0.4-5% of patients and can be

fatal in 0.002% patients(8). In Vićentijevic's

research the most frequent allergies are to

penicillin with 46% of patients reporting

allergies to drugs(9) or in Dmitrović R. and

Zivanovic S.(10) research 56.13% of pa-

tients are reporting allergies to drugs.

"New penicillin allergies were reported

more commonly after parenteral (0.85%)

compared with oral (0.74%) exposures.

Only 1 of 1543 (0.065%) oral and 1 of 1030

(0.097%) parenteral penicillin-associated

allergy reports were confirmed to be ana-

phylaxis”(11).

Patients allergic to penicillin use more of

wide-spectrum antibiotics, more fluoroqui-

nolones, and have a higher estimated Clos-

tridium difficile risk(12). Treatment of pa-

tients allergic to penicillin with a wide

spectrum of antibiotics leads to multiple

side effects, higher costs and the creation of

multi-resistant strains(13). "In patients with

an allergy to penicillin documented in their

medical records the total number of pre-

scriptions increases. "Total number of pre-

scriptions were increased in patients with a

PenA record. PenA records are common in

the general population and associated with

increased/altered antibiotic prescribing and

worse health outcomes"(14). "Prevalence of

Pen-A registration in hospitalized patients

is high, has high impact on antibiotic pre-

scribing, and is associated with a higher

risk of readmission. Verification of the Pen-

A in hospitalized patients might restrict the

use of reserve antibiotics and improve pa-

tient outcome"(15). In literature, manifesta-

tions that are reported as allergic reactions

to penicillin are listed according to fre-

quency: rash, unknown/undocumented,

hives, swelling/angioedema, anaphylaxis,

as well as itching, dyspnea, nausea/

vomiting, diarrhea, palpitations, headache

and ocular toxicity. According to the

CDC, the following symptoms can be clas-

sified as IgE-mediated reaction to penicil-

lin: reactions that occur immediately or



45

usually within one hour, hives, angioedema,

wheezing and difficulty breathing, symp-

toms and signs of anaphylactic reactions –

affecting at least two of the following sys-

tems - Skin: hives, redness, itch and/or an-

gioedema; Respiratory: cough, congestion,

difficulty breathing, chest tightness, wheez-

ing, constriction of airways/closing of the

throat, change in voice quality; Cardiovas-

cular: hypotension, tachycardia or less fre-

quently bradycardia, tunnel vision, chest

pain, sense of imminent death, loss of con-

sciousness; Gastrointestinal: nausea, vomit-

ing, stomach cramps, diarrhoea(16).

Scope:

The scope of study was to evaluate

patients’ statements on adverse reactions

they experienced after receiving parenteral

penicillin and what was later diagnosed as a

true allergic reaction.

Methodology:

The study is a cross-sectional study, a

retrospective analysis of the work of one

doctor in the City Institute for EMS Bel-

grade from 27.07.2017 to 28.12 2018 on a

total of 2481 patients.

When a patient contacts our call centre, we

start a paper protocol and an electronic form

in MS Access database which is later

printed as a report. In taking their history

patients are asked whether they are allergic

to any drugs, i.e. if there are any drugs they

should not take. If the answer is yes, and

one or more drugs are cited, then they are

asked what happened the last time when

they took the drug, i.e. what reaction oc-

curred, so that it was diagnosed as an al-

lergy. For example, an allergy diagnosis

made by a doctor who told the patient after

an adverse reaction that she was allergic to

the drug and that she should no longer use it.

Sometimes they state that they had an ad-

verse reaction in their childhood, which is

when they were told that they were allergic

to the drug, i.e. they can’t explain exactly

what happened. The allergy data obtained

are entered in the corresponding field, i.e.

drug allergy field, which is then analyzed.

Patients who responded that they should not

take penicillin products because of the al-

lergic reaction experienced after parenteral

administration of penicillin were taken into

consideration as those were considered con-

firmed allergic reactions.

Inclusion criteria: if a patient has experi-

enced a reaction after receiving parenteral

penicillin, and at another time in a separate

event they experienced an adverse reaction

to another drug, they were included in the

study.

Exclusion criteria: if a patient received

penicillin and another drug at the same

time, then that patient was not included in

the study. Oral penicillin preparations and

their related adverse reactions were not

taken into account. They were recorded

separately when entering data about pa-

tients. When running queries a few patients

showed up more than once. Their claims of

having drug allergies were compared. If

their answers to the question about drug

allergies were consistent each time, only

one entry was made and the rest were de-

leted. If, on separate occasions, their an-

swers were inconsistent all the entries for

those patients were deleted as we consid-

ered them unreliable.

In the end there were 242 patients left for

analysis, accounting for 9.8% of the total

number of patients examined. The data was

then exported to an Excel spreadsheet,

where the sort and count search was per-

formed. Statistical testing of χ2 test contin-

gency tables and descriptive statistics in

SPSS 11 for Windows.



46

In the end there were 242 patients left for

analysis, accounting for 9.8% of the total

number of patients examined. The data was

then exported to an Excel spreadsheet,

where the sort and count search was per-

formed. Statistical testing of χ2 test contin-

gency tables and descriptive statistics in

SPSS 11 for Windows.

Results:

Of the 2481 patients, 242 stated they

had experienced some adverse reactions to

parenteral penicillin, which was diagnosed

by a physician as an allergic event.

Of that number 82 patients did not know

what happened. Of the 71 who were de-

clared allergic to penicillin in their child-

hood, only 9 were able to explain what reac-

tion exactly occurred.

Therefore, for the analysis we were left with

160 patients who were able to explain what

exactly happened and they listed 204 ad-

verse reactions in total.

Patients were aged between 18 and 85 years

old. X2=49.64 sd=17.243.

There were 55 male patients, i.e. 34.4% and

104 female patients, i.e. 65%, patients of

unknown gender were 0.6% χ2=16,685

p



47

Discussion:

Out of 242 patients, 160 were able to

explain what kind of reaction they had after

drug administration. The group had an aver-

age age of 49.64, with the majority of them

being female and with most commonly re-

ported reactions being skin reactions like

rash, hives, redness, blisters or itchiness,

then loss of consciousness, eyelid, face or

mouth swelling, as well as swelling of the

arms or hands. They experienced dyspnea,

ringing or pulsing in the ears, then less fre-

quently they reported fainting, blackouts,

dizziness, coma, mouth distortion, vomit-

ing,tongue tingling, heart palpitations etc.

The limitation of our study is in the fact that

our data was taken verbally from the pa-

tients who described in their own words the

adverse reactions they experienced that were

later diagnosed as penicillin allergy, i.e. we

were not in the position to verify their self-

reported allergies as we had no access to

their medical records.

Depending on a study, the number of pa-

tients reporting penicillin allergy is ranging

from 8-12% depending on the populations

evaluated(6). In a study from Boston, USA,

“again, the most commonly reported drug

intolerances, in this somewhat older popula-

tion, were to penicillins, with 12.8% report-

ing an “allergy”(7). In a study from France,

9.4% of patients stated they were allergic to

penicillin(17). In 7 -15% of children there is

a suspected allergic/hypersensitivity (HS)

reaction to drugs, especially antibiotics (18).

In Great Britain, based on a study on medi-

cal records of 2.3 million of adult patients

the prevalence to penicillin allergy is at

5.9%, more frequently in older patients, fe-

males and patients with co-morbidities as

stated by their GPs(14). In our study, that

percentage is at about 10%.

In the research from Macy E, Romano A,

Khan D it is stated that “antibiotic allergy

prevalence increases with increasing age

and is more common in hospitalized popu-

lations and in populations that use more an-

tibiotics”(19).

In the study by Macy et al there is a larger

representation of females 9.46% as com-

pared to males 5.93%(1). “Antibiotic al-

lergy incidence rates are sex dependent,

higher in females than in males” (19). The

most common allergic reactions were rash

(37%), unknown/undocumented (20.2%),

hives (18.9%), swelling/angioedema

(11.8%)“(6). Most commonly exhibited ad-

verse reactions to administration of par-

enteral penicillin are skin rashes and itchi-

ness, dyspnea and wheezing, swelling of

eyelids, face or mouth, tongue swelling or

redness, fever or shivering, joint pains, sud-

den drop in blood pressure (8).

According to CDC(16), out of all adverse

reactions that can be categorized as allergic

reactions according to drug information

sheets, in our study we had redness, itchi-

ness, hives, rash, swelling of eyelids, face,

mouth, tongue, dyspnea, loss of conscious-

ness, fainting, blackout or blurred vision,

nausea, vomiting, tingling of tongue, palpi-

tations, hand tingling, seeing stars, shock,

drop in BP, sinking feeling, numbness, tight

throat feeling, Table number 1. As many as

82 of our patients of the total of 242, i.e.

33.9%, state they are allergic to penicillin

but are unable to list even one symptom of

what happened in their allergic reaction. 71

patients of 242, i.e. 29%, state they have

penicillin allergy since childhood. Other

researchers also state this as a fact, i.e. that

a large percentage of patients who are re-

porting penicillin allergy have had it since

childhood (5).



48

The most common allergic reaction is rash,

as stated in multiple studies. “Overall, im-

proved referral to an allergist will help to

identify patients who have penicillin allergy

requiring avoidance”(6). In the study by

Branelec A et al, skin rash is present in

58.6% of cases and 13.1%have reported se-

rious adverse reactions such as coma or ur-

gent hospitalization with anaphylactic shock

being the case in 8.8%(17). Only one of our

patients reported having been in ‘shock’

even though conditions like unconscious-

ness, coma and shock account for 33.9% of

total adverse reactions.

“Diagnosis of drug allergy is largely based

on clinical history because diagnostic tests

are limited. Most patients who are labelled

as having penicillin allergy can tolerate

penicillins after allergy evaluation”(20).

Many patients report being allergic to peni-

cillin, but only very few of them have clini-

cally significant reactions(21). Even in our

study we had somewhat lighter adverse re-

actions reported after administration of peni-

cillin, i.e. skin rash, itchiness or redness of

skin, dizziness, tongue numbness etc. Table

number 1.

In the study of Kusic et al it is stated that

“the most common initial symptoms were

rash(exanthema) and angioedema. None of

the patients with self-reported allergic reac-

tion to penicillin had positive in vitro tests.

Total number of patients with positive in

vivo tests is 2/81 (2.5%)”(13)."Something

completely else, but clearly not an immu-

nologically mediated reaction, such as a

pharmacologic reaction, expected side ef-

fect, headache, yeast infection, gastrointesti-

nal upset, viral exanthem, other benign reac-

tion or association, fear, or some unknown

reaction, account for the majority of penicil-

lin “allergies” reported in the electronic

health record (EHR), approximately 95% to

97%”(1). In our study we had a good por-

tion of such reactions. Table number 1. Not

all self-reported allergies are true drug al-

lergies. Adverse reactions can be truly aller-

gic but also pseudo-allergic such as: dizzi-

ness, palpitations, visual and hearing distur-

bances, change in consciousness, skin

changes(8). Among the adverse reactions

we have recorded and that fall under the

pseudo-allergic procaine reaction or other

immunological reaction cited in the drug

information sheet or a neurotoxic reaction

(8) are: dizziness, buzzing or pulsing in the

ears, feeling of numbness in tongue and

arms, heart palpitations, stiffness, mouth

distortion, foaming at the mouth, seeing

stars, palsy, hearing sounds, ‘wave’ going

through the body, twisted tongue, increased

epilepsy symptoms, etc. Table number 1.

These reactions are not listed in the drug

information sheets but could be the result of

Hoigne's syndrome, which occurs after in-

tramuscular administration of penicillin G

procaine. Hoigne’s syndrome manifests it-

self as severe psychomotor agitation with

confusion, a sense of disintegration, deper-

sonalization and derealization, a sense of

change in body shape, visual and auditory

hallucinations, panicked fear of death,

changes in consciousness and epileptic sei-

zure(8). Only one in 1543 patiens (0.065%)

with oral administration and one in 1030

(0.097%) with parenteral penicillin associ-

ated administration were confirmed as cases

of anaphylaxis(11), and only one of our pa-

tients stated that he experienced "shock",

but several of them stated they wereuncon-

scious which could indicate a serious reac-

tion or perhaps even an anaphylaxis, Table

number 1. “Most patients who report peni-

cillin allergy can tolerate penicillins without

having an adverse or hypersensitivity reac-

tion. Unfortunately, most patients do not

undergo penicillin allergy testing, which



49

leads to use of alternative antibiotics that

result in increased morbidity. This increased

morbidity leads to a significant detrimental

economic effect on health care. In patients

with negative test results, most recurrent

reactions are benign rashes. There is always

a fear that an anaphylactic reaction would

occur on re-exposure to a penicillin; how-

ever, multiple studies have found that this is

an extremely rare occurrence”(22). Al-

though anaphylaxis is a rare occurrence, it is

not possible to remove responsibility for ad-

ministering penicillin to patients who indi-

cate that they are allergic to penicillin.

Penicillin allergy may be a serious adverse

reaction that affects the possibility of anti-

bacterial treatment. Although it is often re-

corded in medical records, only a minority

of patients with a recorded penicillin allergy

actually have a confirmed allergy. “The

term 'allergy' may be incorrectly applied to

adverse reactions that do not have an immu-

nological basis and inappropriate labelling

of penicillin allergy can lead to the unneces-

sary avoidance of penicillins and other beta-

lactam antibacterials"(23). Given the in-

creasing resistance to antibiotics, and that

penicillin remains a highly effective medi-

cine in the fight against many infections, the

fact that the number of reported allergies is

more than 10 times higher than the number

of actual allergies is a serious health prob-

lem(16).

Most children who report an allergy to a

multi-class drug or a family of antibiotics

are not allergic to these drugs. In these chil-

dren, one would think of allergic or non-

allergic intolerance or hypersensitivity to

other drugs, often given in addition to anti-

biotics (non-opioid analgesics, antipyretics

and non-steroidal anti-inflammatory drugs

in particular)(18).

“Verification of the penicillin allergy in

hospitalized patients might restrict the use

of reserve antibiotics and improve patient

outcome”(15).

“Establishing true penicillin allergy status

(e.g. oral challenge testing) would allow

more people to be prescribed first-line anti-

biotics, potentially improving health out-

comes”(14). “Seven to 15% of children re-

port suspected allergic/hypersensitivity

(HS) reactions to drugs, antibiotics espe-

cially, but studies based on clinical history,

skin tests (ST) and drug challenge/

provocation tests (DPT) have shown that

only 10–15% of these children were truly

allergic, except for the children reporting

immediate and/or severe reactions”(18).

About 10% of the population reports an al-

lergy to penicillin, but after testing, up to

90% of these patients do not have an al-

lergy to penicillin(24).

“Antibiotics are the commonest cause of

life-threatening immune-mediated drug re-

actions and many antibiotic reactions docu-

mented as allergies were unknown or not

remembered by the patient. Antibiotic al-

lergy labels result in displacement of first-

line therapies for antibiotic prophylaxis and

treatment which is associated with in-

creased use of broad-spectrum and non-β-

lactam antibiotics, which results in in-

creased adverse events and antibiotic resis-

tance. Most patients labelled as allergic to

penicillins are not allergic when appropri-

ately stratified for risk, tested, and re-

challenged”(25). “An unconfirmed penicil-

lin “allergy” is a significant health risk and

testing can significantly lower this risk” (7).

In the study of Kusic et al “adverse effects

to penicillin were reported by 70/81

(86.4%) tested patients. None of the 70 pa-



50

tients with self-reported allergic reaction to

penicillin had positive in vitro tests. Total

number of patients with positive in vivo

tests is 2/81 (2.5%)"(13).

Penicillin allergy testing is an intervention

that through the analysis of assumed sensi-

tivity is a less expensive option and saves

money(12).

Establishing the true status of penicillin al-

lergy will allow more people to be pre-

scribed the first line of antibiotics and possi-

bly improve patient health outcomes.

The best method for determining IgE-

mediated penicillin allergy is a skin test

(13). Skin testing is associated with frequent

false positives and false negatives(1).

The negative predictive value of the skin

test is more than 95%, and when checked

with a single oral dose of the drug it is close

to 100% while the positive predictive value

is between 40% and 100% (16). Vićentijević

states that in 23% of patients, drug allergy

has been further tested and confirmed by

analysis(9).

However, only 6% of patients who report an

allergy have a confirmed report from an al-

lergy specialist. All in all, a confirmed con-

sultation with an allergist helps to detect pa-

tients with penicillin allergy and require

drug avoidance"(6). Still, the problem is that

there are millions of patients with the need

to have their penicillin allergy either con-

firmed or dismissed.

Doctors and patients who should be given

penicillin are in favour of testing, although

all those who have been labeled as allergic

are not convinced about the benefit of the

study.

The problem with allergy to penicillin and

other drugs could also be in the legal regula-

tions, i.e. in the actual reporting process. In

order to report an allergy to the drug, it is

sufficient that a doctor suspects it based on

the adverse reaction.

Conclusion:

The most common reactions after ad-

ministration of parenteral penicillin are cu-

taneous manifestations, loss of conscious-

ness, swelling of the tongue and face, dysp-

nea. About 40% of what our patients report

is a serious reaction like loss of conscious-

ness and dyspnea. One portion of all re-

ported reactions could be classified as non-

allergic reactions or adverse drug reactions.



51

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6. Albin S, Agarwal S. Prevalence and

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7. Zhou L, Dhopeshwarkar N, Blumen-

thal KG, Goss F, Topaz M, Slight SP, et al.

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ler CC, Howard P, Bates C, et al.

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Primljen - Received 16.11. 2020.

Prihvaćen - Accepted 17.12. 2020.

Marta S Ljubisavljević, Slavoljub R Živanović. ABC časopis urgentne medicine 2020;20:(3):43-53

Korespodencija /Correspondence to Slavoljub Živanović [email protected]

53



1Dom zdravlja "Milutin

Ivković" Palilula, Belgrade

2 Gradski zavod za hitnu

medicinsku pomoć Beograd

Srbija

Samoprijavljene alergije na parenteralno dati penicilin

Uvod: Penicilin i penicilinski preparati su u svakodnevnoj

medicinskoj praksi. Najčešća prijavljena reakcija na lek je na

penicilin. Nove Penicilinske alergije su češće posle primene

parenteralnog nego oralnog puta davanja. Kod pacijenata koji su

alergični na penicilin, se češće primenjuju antibiotici širokog

spektra, a terapija je skuplja. Alergije na penicilin su imunološki

posredovane.

Cilj rada je bio: Pokazati tvrdnje pacijenata koji su izjavili da su

alergični na penicilin, kakvu su reakciju doživeli posle

parenteralnog dobijanja penicilina.

Metodologija: Retrospektivna studija rada jednog lekara u

GZHMP Beograd u periodu 2017 do 2018 godine na 2481

pacijenata.

Rezultati: Pronađeno je 242 pacijenta koji su dali podatak da su

alergični na peniclin, a 160 je znalo da kaže šta se desilo posle

dobijanja parenteralnog penicilina. Ispitivana grupa je starosti od

18-85 godina, prosečne starosti 49,64 +- 17,24 godina, dok je

65% osoba bilo ženskog pola. Najčešće prijavljene reakcije su

bile ospe, crvenilo I svrab po koži, potom gubitak svesti, a zatim

otok lica usana jezika kože tela ili ruku. Ozbiljne reakcije su se

javile u oko 40% slučajeva.

Zaključak: Veliki je procenat samoprijavljene alergije na

penicilin, a mali je broj onih koji su doživeli ozbiljne reakcije:

otok, bez svesti gušenje, koma ili šok.

Ključne reči: Primarna zdravstvena zaštita, alergije na penicilin,

parenteralna primena, hitna medicinska pomoć.

I

Uputstvo autorima/Instrucions to the autors ——————————————————————————————————————————–


UPUTSTVO SARADNICIMA

ABC ĉasopis urgentne medicine objavljuje

prethodno neobjavljene nauĉne i struĉne

radove iz oblasti medicine koja se odvija na

na prehospitalnom i inicijalno hospitalnom

nivou kao i onih oblasti medicine koje mogu

biti od interesa za lekara koji radi u službi

Hitne Pomoći. Za objavljivanje se primaju

originalni radovi, prikazi sluĉaja, pregledni

ĉlanci i ĉlanci iz istorije medicine, koji nisu

do sada objavljivani, kao i da radovi koji

nisu podneti za objavljivanje u drugom

ĉasopisu

Vrste radova koje se objavljuju u časopisu:

1. Originalni naučni (stručni) rad ili prikaz

slučaja. Pod originalnim naučnim radom se

podrazumeva rad u kome se prvi put

objavljuju rezultati sopstvenih istraživanja.

2. Pregledni rad koji sadrži originalan,

detaljan i kritički prikaz istraživačkog

problema ili područja u kome je autor već

ostvario određeni doprinos, prikazan u vidu