"Feedback regarding care for my child at Emergency Department"

I am writing to provide feedback regarding the care my child received through Kununurra Hospital Emergency Department.

My child has a significant history of severe drug allergy, including Stevens-Johnson syndrome following a previous medication exposure. This places my child in a high-risk category for any new antibiotic exposure or suspected drug reaction.

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Initial presentation 

We attended the Emergency Department after hours due to concern for a possible staphylococcal skin infection. A swab was taken and we were discharged without medication, which I accepted at the time. However, no clear follow-up plan was provided while awaiting results.

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Second presentation 

We returned a few days later after results were available and waited a significant period before review. My child was commenced on cephalexin (oral antibiotic) and topical treatment for an ongoing undiagnosed rash on their arm, with concern for secondary infection.

My child took cephalexin as prescribed and we applied the topical treatment.

Over the following days, the area consistent with suspected staphylococcal infection improved significantly and dried out, suggesting a good response to antibiotics. However, the secondary rash persisted and became more inflamed during ongoing topical treatment.

This rash had been present for several months prior to presentation. We had already trialled multiple treatments over more than six months, including over-the-counter antifungal preparations and topical steroid treatments, without improvement. It remained undiagnosed and persistent despite these attempts.

The topical treatment prescribed was Otocomb Otic.

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Deterioration and third presentation 

By day three of treatment, we became concerned about worsening symptoms. Importantly, the secondary rash appeared to be worsening in the context of ongoing Otocomb Otic use, while the suspected staphylococcal infection had improved and dried out with cephalexin.

At the same time, my child developed mild lip blistering and discomfort. Given their history of Stevens-Johnson syndrome and prior antibiotic sensitivities, I was concerned about a possible early drug hypersensitivity reaction.

After approximately 12 hours of worsening symptoms, we returned to the Emergency Department.

We waited several hours before assessment. While staff were kind and professional, the lip changes were assessed as likely minor (such as cold sores), and the secondary rash was again considered an undiagnosed benign rash. I reiterated that we had already trialled antifungal and topical steroid treatments over more than six months without improvement.

We were advised to discontinue cephalexin after only three days and return home.

A remote consultation with another hospital immunology was reportedly undertaken. Despite this, we were advised to manage at home and return only if severe symptoms developed, and to follow up with a GP for ongoing care.

Given the limited access to urgent GP services in Kununurra, this was not a practical option in the context of ongoing concern.

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Follow-up care

We obtained a private GP review a few days after. Skin scraping was performed due to concern for secondary infection. My child was prescribed topical steroids and given flucloxacillin as a safer antibiotic option if required.

This review suggested that further investigation and closer monitoring may have been appropriate earlier.

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Key concerns

While I acknowledge the pressures on regional emergency departments and found staff to be polite and professional, I have the following concerns:

* My child has a documented history of Stevens-Johnson syndrome and is high risk for drug reactions

* Limited escalation or specialist input despite this history

* Persistent rash over several months with no response to antifungal or topical steroid treatment, yet no clear diagnostic progression

* Discharge without a clear monitoring or safety plan appropriate to my child's risk profile

* Advice to follow up with a GP was not practical given limited access in Kununurra

* No follow-up communication from the other hospital's immunology or dermatology

* I felt my child's high-risk history was not fully weighted in decision-making

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Outcome

My child’s symptoms have since improved, though the exact cause remains unclear.

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Closing

I am providing this feedback to highlight concerns regarding continuity of care, escalation pathways for high-risk paediatric patients, and access to specialist input in regional emergency settings.

I would appreciate review of this case to help improve care pathways for children with known severe drug allergy histories in rural and remote hospitals.