#66 – The Swinging PEN-dulum: Evolving Approaches to Cephalosporin Use in Penicillin Allergic Patients
Breakpoints
Penicillin Allergy and the Risks of Avoiding Cephalosporins
There are risks of avoiding cephalosporins or beta lactams when they're the drug of choice. And this occurs essentially throughout the US, we know in patients who have unconfirmed penicillin allergies. These consequences are often unappreciated but can include an increased risk of surgical site infection,. Increased rates of drug resistant infections and increased health care utilization.
Dr. Kimberly Blumenthal (@KimberlyBlumen1), Dr. Meghan Jeffres (@PharmerMeg), and Dr. Eric Macy (@EricMacyMD) join Dr. Julie Ann Justo (@julie_justo) to summarize the history of cephalosporin avoidance in penicillin allergies, evidence-based pros and cons of giving cephalosporins in penicillin allergy, how to leverage technology to improve treatment of patients with penicillin allergies, and much more!
Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/
References
- Macy E. Why Was There Ever a Warning Not to Use Cephalosporins in the Setting of a Penicillin "Allergy"? J Allergy Clin Immunol Pract. 2021 Nov;9(11):3929-3933. doi: 10.1016/j.jaip.2021.06.059. PMID: 34303019.
- Liang EH, et al. Adverse Reactions Associated with Penicillins, Carbapenems, Monobactams, and Clindamycin: A Retrospective Population-based Study. J Allergy Clin Immunol Pract. 2020 Apr;8(4):1302-1313.e2. doi: 10.1016/j.jaip.2019.11.035. PMID: 31821919.
- Macy E, Contreras R. Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis. J Allergy Clin Immunol. 2015 Mar;135(3):745-52.e5. doi: 10.1016/j.jaci.2014.07.062. PMID: 25262461.
- Macy E, et al. Population-Based Incidence of New Ampicillin, Cephalexin, Cefaclor, and Sulfonamide Antibiotic "Allergies" in Exposed Individuals with and without Preexisting Ampicillin, Cephalexin, or Cefaclor "Allergies". J Allergy Clin Immunol Pract. 2022 Feb;10(2):550-555. doi: 10.1016/j.jaip.2021.10.043. PMID: 34757066.
- Picard M, et al. Cross-Reactivity to Cephalosporins and Carbapenems in Penicillin-Allergic Patients: Two Systematic Reviews and Meta-Analyses. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2722-2738.e5. doi: 10.1016/j.jaip.2019.05.038. PMID: 31170539.
- Romano A, et al. Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2016 Jul;138(1):179-186. doi: 10.1016/j.jaci.2016.01.025. PMID: 27016799.
- Romano A, et al. Cross-Reactivity and Tolerability of Cephalosporins in Patients with IgE-Mediated Hypersensitivity to Penicillins. J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1662-1672. doi: 10.1016/j.jaip.2018.01.020. PMID: 29408440.
- Blumenthal KG, et al. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk. Clin Infect Dis. 2018 Jan 18;66(3):329-336. doi: 10.1093/cid/cix794. PMID: 29361015.
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- Blumenthal KG, et al. Recorded Penicillin Allergy and Risk of Mortality: a Population-Based Matched Cohort Study. J Gen Intern Med. 2019 Sep;34(9):1685-1687. doi: 10.1007/s11606-019-04991-y. PMID: 31011962.
- Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study. J Allergy Clin Immunol. 2014 Mar;133(3):790-6. doi: 10.1016/j.jaci.2013.09.021. PMID: 24188976.
- AAAI. Choosing Wisely. 2014 Mar 3. https://www.choosingwisely.org/clinician-lists/american-academy-allergy-asthma-immunlogy-non-beta-lactam-antibiotics-penicillin-allergy/
- Jeffres MN, et al. Systematic review of professional liability when prescribing β-lactams for patients with a known penicillin allergy. Ann Allergy Asthma Immunol. 2018 Nov;121(5):530-536. doi: 10.1016/j.anai.2018.03.010. PMID: 29551402.
- Macy E, et al. Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing. JAMA Netw Open. 2021 Apr 1;4(4):e218367. doi: 10.1001/jamanetworkopen.2021.8367. PMID: 33914051.
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- Jeffres M. Penicillin and/or Beta-Lactam Allergy Tip Sheet & Cross-reactivity Table. https://drive.google.com/file/d/1cokYXnSDlO3vk8ke1LaalPz4iavuNSV8/view?usp=share_link
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- Iammatteo M, et al. Safety and Outcomes of Oral Graded Challenges to Amoxicillin without Prior Skin Testing. J Allergy Clin Immunol Pract. 2019 Jan;7(1):236-243. doi: 10.1016/j.jaip.2018.05.008. PMID: 29802906.
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- DePestel DD, et al. Cephalosporin use in treatment of patients with penicillin allergies. J Am Pharm Assoc (2003). 2008 Jul-Aug;48(4):530-40. doi: 10.1331/JAPhA.2008.07006. PMID: 18653431.
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