Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

Abstract

Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.

Antibiotic-Resistant and Non-Resistant Bacteria Display Similar Susceptibility to Dielectric Barrier Discharge Plasma

“…Clinical isolates of antibiotic-resistant Escherichia coli were first isolated in the 1970s [ 3 ], soon followed by strains with extended-spectrum β-lactamase (ESBL) genes, which confer resistance to third generation cephalosporins [ 4 ], which are the most commonly prescribed classes of antibiotics with bactericidal activity [ 5 ]. Multiple resistant bacteria are now a major problem in human and veterinary medicine, especially for nosocomial infections [ 3 , 6 ].…”

Cefiderocol: A Novel Agent for the Management of Multidrug-Resistant Gram-Negative Organisms

“…It is also unclear if there is a significant cross-reactivity between penicillins or cephalosporins and cefiderocol. While cefiderocol does not appear to share a similar side with any penicillins, it shares the same R1 side chain with aztreonam and ceftazidime and a similar R2 side chain with cefepime [47].…”

Cephalosporins’ Cross-Reactivity and the High Degree of Required Knowledge. Case Report and Review of the Literature

“…Cephalosporins represent one of the most commonly prescribed classes of antibiotics for pulmonary, skin and soft tissue infections due to their broad spectrum of activity and low toxicity profile. Anaphylactic reactions from cephalosporins are extremely rare and the incidence of allergy is estimated to be 1-3% of the general population [26,27]. A French report in 2005 described a 27% prevalence of severe allergic reactions to cephalosporins among all cases involving β-lactams [28].…”