Beta-lactam Allergy risk assessment |
CROSS-REACTIVITY SIDE-CHAIN CHART |
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More information
Frequently Asked Questions - CLINICIANScan I use cefazolin in patients with history of anaphylaxis to beta-lactams?
Cefazolin can be given to patients with a history of anaphylaxis to PENICILLIN.
References:
can I use a cephalosporin in a patient with A cephalosporin allergY?
Are the recommendations different for a pregnant patient?
"Cefazolin can be recommended for antimicrobial prophylaxis in most patients with a history of penicillin allergy, including those with a history of an anaphylactic reaction to penicillin" - Journal of Obstetrics and Gynecology Clinical Opinion Article 2024 This matches the recommendations for non-pregnant patients. Reference:
What is the risk of Alternative Antibiotics?
The use of alternative non-beta-lactam antibiotics such as clindamycin, fluoroquinolones, and vancomycin have been associated with negative consequences resulting in treatment failure, adverse events, drug reactions, antibiotic resistance, healthcare-associated infections, and a rise in healthcare costs. Patients with a penicillin allergy history who resort to a non-beta-lactam antibiotic for common infections have a 23% increased odds of C. difficile infection, a 14% increased odds of MRSA infection, and 30% increased odds of VRE infection. References:
Do I need to test a patient with penicillin allergy before USING cephalosporin?
No, routine penicillin allergy testing (i.e. penicillin skin test and/or drug challenges) when assessing for tolerance to a cephalosporin in the setting of an unconfirmed* penicillin allergy does not improve overall patient safety or clinical outcomes because of the high number needed to treat, time, expense, and the low likelihood of such testing occurring, and will potentially result in ever greater use of less effective none beta-lactam antibiotics. *unconfirmed penicillin allergy: a reported adverse reaction or intolerance after receiving a penicillin without verification of an IgE-mediated reaction (i.e. penicillin skin test and/or drug challenge) References:
What Is the cross reactivity between penicillins and cephalosporins?
The cross reactivity between penicillin and cephalosporins occurs in about 2% of cases. Prior rates of 8-10% were an over estimation of the degree of cross-reactivity between beta-lactams due to 1) cephalosporins contaminated with benzylpenicillin, 2) inclusion of in-vitro and retrospective studies not supported by skin testing, and 3) diagnosis of penicillin allergy based primarily on clinical history. References:
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Frequently Asked Questions - PATIENTSWhat is penicillin?
Penicillin is an essential antibiotic available in the US since 1945. A variety of penicillin and cephalosporin antibiotics make up the beta-lactam family, which are recommended first-line for many common bacterial infections today. If I have a penicillin allergy, is it safe to get a cephalosporin?
Yes. Cephalosporins are cousins of penicillin, structurally different enough to be safely given to patients with a reported penicillin allergy. Cefazolin, a cephalosporin, can even be given in patients with history of anaphylaxis to penicillin. My parent is allergic to penicillin, does that mean I am too?
No. Penicillin allergy has not shown to be genetic. You cannot become penicillin allergic if a family member is also allergic. Do I still have a penicillin allergy if it was a childhood reaction?
It is unlikely. About 35 million Americans report a penicillin allergy, however, over 90% of these reported reactions are not true allergies or become less severe over time. Childhood reactions to penicillin could have been mistaken for a reaction due to the infection and studies have shown over 80% of a true allergic reaction to penicillin are milder if over 10 years original reaction. |