3. Mr A complains the Trust gave his mother, Mrs A, penicillin from 15 May 2024 until her discharge from hospital on 27 May despite her being allergic to this, and having chronic kidney disease.
4. Mr A said this caused irreversible damage to his mother and she sadly died a month later. This has had a devastating effect on him and has made him lose faith in the NHS.
5. The outcomes he seeks are an acknowledgement of failings, an apology and service improvements.
6. Mrs A was admitted to the Trust on 15 May 2024 with shortness of breath and swelling to her left knee. When she was admitted she was seen by a doctor in the emergency department (ED), who noted ulcers on her left leg, thought to be infected. The Trust prescribed flucloxacillin (a penicillin antibiotic) to treat the infection.
7. She was transferred to the acute medical unit (AMU), then to a ward on 17 May where she stayed until her discharge.
8. When she was transferred to the AMU the team noted the penicillin allergy, and they discussed her case with the microbiologist. The Trust continued to give Mrs A treatment with antibiotics.
9. Mr A told us his mother had an allergic reaction. The Trust complaint response said her reactions were more likely sepsis, and there was no evidence of the usual symptoms which would often be seen in allergies.
10. Mrs A was discharged on 27 May 2024 and sadly died a month later.
14. Mr A told us the Trust should not have given his mother penicillin. We looked first to see if there were indications of failings in the Trust’s decision to give flucloxacillin in the ED when she was admitted.
15. Our adviser told us that when Mrs A was admitted to hospital she was very unwell. It is their opinion she was in serious danger of developing sepsis and if the Trust had not treated her with flucloxacillin, it is likely she would have died within a day or two. They explained Mrs A had a bacterial infection as a result of her leg ulcers, and flucloxacillin is used to treat bacterial infections.
16. The initial treatment the Trust gave, with immediate life saving penicillin antibiotics, was in line with GMC Good Medical Practice which says:
‘In providing clinical care you must:
• adequately assess a patient’s condition(s), taking account of their history, including symptoms […] • carry out a physical examination where necessary • promptly provide (or arrange) suitable advice, investigation or treatment where necessary • propose, provide or prescribe drugs or treatment (including repeat prescriptions) only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment will meet their needs • propose, provide or prescribe effective treatment based on the best available evidence’
17. We can see the Trust took a full history, carried out an examination, noted the likely diagnosis of sepsis and then prescribed the single dose of flucloxacillin. This was all in line with the guidance above.
18. At the point the flucloxacillin was prescribed there is nothing to show the treating team had the information that Mrs A had an allergy to penicillin, and so it was reasonable and in line with the guidance to give it.
19. The first appearance in the records of mention of an allergy to penicillin was on 15 May, on transfer from the ED to the AMU. This was after the flucloxacillin had been given. The records note ‘Hx [history] from son or pt [patient]’ and ‘penicillin – rash’.
20. We understand how worrying it must have been for Mr A to see his mother’s symptoms. Our adviser told us there is no evidence Mrs A had an adverse reaction to the flucloxacillin. They considered the symptoms she was experiencing were due to sepsis.
21. The Trust took a cautious approach when it became aware of the information in paragraph 19, and changed to an antibiotic that would be less likely to cause an allergy. This was cefuroxime which is not a penicillin and is often given to patients with a penicillin allergy.
22. Our adviser told us this was a reasonable choice, as this would be less likely to cause the side effect claimed for penicillin.
23. The Trust made the decision following discussion with a microbiologist. As time passed, Mrs A’s condition improved and the Trust changed the antibiotic to doxycycline. These actions were in line with GMC Good Medical Practice which says:
‘propose, provide or prescribe effective treatment based on the best available evidence’ and ‘consult colleagues or seek advice from your supervising clinician, where appropriate’.
24. Both doxycycline and cefuroxime are considered by the British National Formulary (BNF) guidance as safe to use, under cautious supervision, for those with a penicillin allergy.
25. There is no evidence Mrs A had ever experienced anaphylaxis (a life-threatening allergic reaction that happens very quickly). The history from Mrs A or her family was that penicillin gave her a rash. In these circumstances our adviser considered the use was reasonable and in line with guidance.
26. There is no evidence that any of the medication used provoked any allergic reaction in Mrs A. In the opinion of our adviser the symptoms were due to the sepsis, and as this resolved so the symptoms lessened. The records show Mrs A’s improvement on 24 May, ‘Patient reports feeling well enough in self, keen to return home, keen to sit out at present’
27. We also considered Mr A’s concern that his mother should not have been given penicillin because of her kidney disease.
28. The BNF advises caution when using flucloxacillin for patients with severe renal impairment. Our adviser told us the test results show Mrs A did not have severe renal disease, although she did have a degree of renal impairment. They explained the impairment was not a reason to not use penicillin.
29. The BNF notes that when using cefuroxime renal function should be monitored in elderly patients and those with known kidney issues to ensure appropriate dosing. We can see this happened daily and so the choice was reasonable.
30. In relation to doxycycline the BNF says ‘Renal impairment — avoid excessive doses’. Our adviser told us the doses were not excessive, and so we consider this was also a reasonable prescription to use.
31. The choice of antibiotics and the doses were in line with what the BNF says can be given for a person with the kind of impaired kidney function that Mrs A had.
32. We are sorry Mr A was left with concerns about the choice of medication the Trust gave his mother. We hope he will be reassured by our careful consideration, and that we found no indications of failings as the decisions were in line with guidance.
1. We have carefully considered Mr A’s complaints. We did not see any indications of failings in the decisions the Trust made when prescribing penicillin.
2. We were sorry to hear about how much this experience affected Mr A. We hope he will be reassured by the information in this statement that there is no further action we need to take.