Un insolito caso di reazione anafilattica da farmaco: cenni clinici e riflessioni medico-legali

Abstract

We report a case of a cutaneous ulcer in a 49 years-old patient with diabetes and hypertension. Penicillin in pownder for local use was prescribed. A severe anaphylactic reaction was observed. This case leads to some considerations concerning the off-label prescribing, that is to say the prescription of a registered medicine for a use that is not included in the product information. Thus off-label prescribing in dermatology may sometimes be clinically appropriate, it may be associated with a number of clinical, safety and legal issues. Off-label prescribing is acceptable if there is no suitable alternative and an appropriate process for informed consent is needed. The practice of prescribing off-label drugs is common among dermatologists, many of whom had misperceptions about which are the approved indications of the drug and about the legal ramifications of off-label therapies. The authors suggest that understanding the principles of off-label prescribing in conjunction with the mechanisms of drug action in diseases may help clinicians in increasing the safety of their patients and in avoiding legal litigations.