In patients allergic to penicillin, consider second and third generation cephalosporins for life threatening infections

Pegler, Scott; Healy, Brendan

doi:10.1136/bmj.39372.829676.47

Cited by 26 publications

(25 citation statements)

References 10 publications

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“…Penicillin allergy is commonly reported in hospitalized patients . However, many patients who carry this label may not have true allergic reactions .…”

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confidence: 99%

Impact of Penicillin Allergy on Empirical Carbapenem Use in Gram‐Negative Bloodstream Infections: An Antimicrobial Stewardship Opportunity

et al. 2017

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OBJECTIVES Retrospective matched-cohort study evaluating association between penicillin allergy and empirical carbapenem use in gram-negative bloodstream infections (BSIs) and utility of antimicrobial stewardship interventions in reducing carbapenem utilization. METHODS Hospitalized adults with community-onset gram-negative BSI from January 1, 2010, to June 30, 2015, at two large community hospitals in Columbia, SC, were identified. Antimicrobial stewardship interventions targeting penicillin allergy and carbapenem utilization were fully implemented January 1, 2014. Multivariate logistic regression was used to examine impact of penicillin allergy and antimicrobial stewardship interventions on empirical carbapenem use. Kaplan-Meier analysis was used to evaluate time to carbapenem deescalation in patients with penicillin allergy before and after interventions. RESULTS Patients with penicillin allergy (n=140) were more likely to receive empirical carbapenem therapy for community-onset gram-negative BSI compared to those without penicillin allergy (n=140) (27% vs 12%, p=0.002). After adjustments in the multivariate model, penicillin allergy (odds ratio [OR] 3.98, 95% confidence interval [CI] 1.98-8.45) and prior b-lactam use (OR 2.72, 95% CI 1.07-6.64) were independently associated with empirical carbapenem use, whereas antimicrobial stewardship interventions were associated with decline in carbapenem utilization (OR 0.41, 95% CI 0.16-0.94). Among patients with penicillin allergy who were prescribed empirical carbapenems, median time to carbapenem deescalation was significantly shorter in the postintervention versus preintervention period (2.0 vs 4.2 days, p=0.004). CONCLUSION Penicillin allergy was a significant contributor to carbapenem use in community-onset gram-negative BSI. This was subject to modification by antimicrobial stewardship interventions, which successfully reduced overall carbapenem use and duration of carbapenem therapy in patients with penicillin allergy.

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“…Penicillin allergy is commonly reported in hospitalized patients . However, many patients who carry this label may not have true allergic reactions .…”

mentioning

confidence: 99%

Impact of Penicillin Allergy on Empirical Carbapenem Use in Gram‐Negative Bloodstream Infections: An Antimicrobial Stewardship Opportunity

et al. 2017

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“…Whether patients with a prior penicillin-allergic reaction are at increased risk for an allergic reaction to a cephalosporin is still a matter of debate [1,2,3,4]. Although the risk is considered very low for most authors [5], severe reactions may occur, as demonstrated by the UK registry on anaphylaxis deaths [6]. Moreover, considering some penicillin-cephalosporin chemical similarities, it is likely that certain cephalosporins may present more risks than others.…”

Section: Introductionmentioning

confidence: 99%

Safety of Cefuroxime as an Alternative in Patients with a Proven Hypersensitivity to Penicillins: A DAHD Cohort Survey

Caimmi

Galera

Bousquet-Rouanet

et al. 2010

Int Arch Allergy Immunol

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Objective: In patients sensitized to β-lactams, a safe β-lactam alternative is often needed. The objective was to assess the safety of cefuroxime in patients with a proven β-lactam allergy. Design: Using the Drug Allergy and Hypersensitivity Database cohort, patients with a proven β-lactam allergy and tested for cefuroxime between September 1996 and April 2007 were selected. The European Network of Drug Allergy recommendations were followed. Prevalence of sensitization to cefuroxime (as an alternative) was established in patients with a proven β-lactam allergy. Results: Amongst the 650 subjects tested, 143 (22.0%) presented at least one β-lactam sensitization other than cefuroxime [39–27.3% male, median age at test 44.0 (32.0–56.0) years]. One hundred and eighteen (82.5%) were sensitized to penicillins, 8 (5.6%) to cephalosporins and 17 (11.9%) to both penicillins and cephalosporins. Nine (6.3%) patients were sensitized to cefuroxime (6 diagnosed by provocation test): 5 (55.6%) in the penicillin-only allergic group and 4 (44.4%) in the penicillin and cephalosporin allergic group. Prevalence of cefuroxime hypersensitivity reaction in patients sensitized to β-lactams was 6.3% (95% CI 2.3–10.3%) and in those sensitized to penicillin 4.2% (95% CI 0.6–7.9). This rate decreased to 2.9% (95% CI 0–6.9) in patients with prior histories involving a penicillin only (without any history involving an unknown β-lactam). Conclusion: Cefuroxime appeared to be a safe alternative in β-lactam-allergic patients after testing. The risk of giving cefuroxime being not null, a thorough drug allergy work-up, including provocation test, is still needed.

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“…1 8 Other second and third generation cephalosporins with a different side chain to the reacting penicillin can be considered, under specialist management, for life threatening infections when non-cephalosporin antibacterials would be suboptimal. 18 The British National Formulary advises that patients with a history of immediate hypersensitivity to penicillin should not receive a cephalosporin. 8…”

Section: Is There Cross Reactivity With Other Antibiotics?mentioning

confidence: 99%

Penicillin allergy—getting the label right

Bulletin¹

2017

BMJ

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In patients allergic to penicillin, consider second and third generation cephalosporins for life threatening infections

Cited by 26 publications

References 10 publications

Impact of Penicillin Allergy on Empirical Carbapenem Use in Gram‐Negative Bloodstream Infections: An Antimicrobial Stewardship Opportunity

Impact of Penicillin Allergy on Empirical Carbapenem Use in Gram‐Negative Bloodstream Infections: An Antimicrobial Stewardship Opportunity

Safety of Cefuroxime as an Alternative in Patients with a Proven Hypersensitivity to Penicillins: A DAHD Cohort Survey

Penicillin allergy—getting the label right

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