Case presentation

A 52-year-old man presents to his GP with cellulitis of the right leg. His allergy record clearly states 'Penicillin: anaphylaxis with throat swelling, 1995'. He has hypertension and ischaemic heart disease, with previous aspirin-associated dyspepsia. The GP issues new prescriptions of co-amoxiclav 625 mg three times daily for 7 days for the cellulitis, plus paracetamol and ibuprofen for pain, alongside his repeat medications. The practice pharmacist queries the prescriptions.

Observations / investigations

Task

Review the drug chart below and answer sub-questions A and B.

AQuestion A

This patient has documented penicillin anaphylaxis. Select the ONE prescription that is absolutely contraindicated because of his allergy record and must be stopped (mark it in column A).

BQuestion B

Select the ONE newly prescribed medicine that should be stopped because, in combination with his long-standing antiplatelet, it significantly increases his risk of gastrointestinal bleeding and may reduce the antiplatelet effect (mark it in column B).