Cephalosporins allergy patients history

Broad intravenous antibiotic coverage for the encapsulated organisms can include ceftriaxone or cefotaxime. For patients with true cephalosporin allergy, clindamycin may be used. If staphylococcal infection is suspected owing to previous history or the patient appears acutely ill, vancomycin should be initiated. Macrolide antibiotics, such as erythromycin and azithromycin, may be initiated if Mycoplasma pneumonia is suspected. While the patient is receiving broad-spectrum antibiotics, their regular use of penicillin for prophylaxis can be suspended. Fever should be controlled with acetaminophen or ibuprofen. Because of the risk of dehydration during infection with fever, increased fluid may be needed.6,27... 

Traditionally, high-dose penicillin G was the treatment standard for meningococcal disease. However, increasing penicillin resistance requires that third-generation cephalosporins now be used for empirical treatment until in vitro susceptibilities are known.23 Patients with a history of type I penicillin allergy or cephalosporin allergy may be treated with vancomycin. Treatment should be continued for 7 days, after which no further treatment is necessary. 

For a patient with a history of penicillin/cephalosporin allergy, expert advice should be sought from a clinical microbiologist. Newer quinolone antibiotics such as levofloxacin and moxifloxacin are possible options but the BTS does not recommend monotherapy with these agents at present. 

Neither in vitro tests nor skin tests reliably predict cephalosporin allergy (166). The true frequency of allergic reactions in penicillin-allergic patients exposed to cephalosporins has been estimated to be 1 or 2% (167). Nevertheless, when there is a history of penicillin anaphylaxis or other severe IgE-mediated reactions, it is wise to avoid cephalosporins. 

Allergy Cephalosporins cause a range of allergic reactions from skin rashes to anaphylactic shock. These reactions occur less frequently with cephalosporins than with penicillins. Complete cross-hypersensitivity between different cephalosporins should be assumed. Cross-reactivity between penicillins and cephalosporins is incomplete (5-10%), so penicillin-allergic patients are sometimes treated successfully with a cephalosporin. However, patients with a history of anaphylaxis to penicillins should not be treated with a cephalosporin. 

Allergenicity is less commonly experienced and is less severe with cephalosporins than with penicillins. Cephalosporins frequently are administered to patients who have had a mild or delayed penicillin reaction. Cross-allergenicity is comparatively common, however, and cephalosporins should be administered with caution for patients who have a history of allergies. Patients who have had a rapid and severe reaction to penicillins should not be treated with cephalosporins. 

The nurse should not administer cephalosporins if the patient has a history of allergies to cephalosporins or penicillins. 

Verify the patient s allergy history and the type of reaction experienced. Attempt to discern between true allergy and adverse event. (3-Lactam-allergic patients may receive clindamycin, vancomycin, or other antimicrobials. Crossreactivity between penicillin allergy and cephalosporins is low but cephalosporins should be avoided in patients with a history of anaphylaxis to penicillins. 

Cephalosporins are sensitizing and may elicit a variety of hypersensitivity reactions that are identical to those of penicillins, including anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, and hemolytic anemia. However, the chemical nucleus of cephalosporins is sufficiently different from that of penicillins so that some individuals with a history of penicillin allergy may tolerate cephalosporins. The frequency of cross-allergenicity between the two groups of drugs is uncertain but is probably around 5-10%. However, patients with a history of anaphylaxis to penicillins should not receive cephalosporins. 

Allergic manifestations The cephalosporins should be avoided or used with caution in individuals allergic to penicillins (about 5 to 15% show cross-sensitivity). In contrast, the incidence of allergic reactions to cephalosporins is 1-2% in patients without a history of allergy to penicillins. 

Two of 178 prospective patients, of whom 151 had a history of penicUUn allergy but were negative on peniciUin skin testing, had reactions to a cephalosporin (153). There were 27 who had a positive peniciUin skin test but did not react to a cephalosporin. SimUar results were found by others (154). 

However, a history of peniciUin allergy is often vague, and many studies have suggested that it is an umeliable indicator, which has been confirmed (155). In 62 peniciUin skin-test-positive patients, cephalosporins produced only one reaction of mild urticaria and bronchospasm (156). 

Cross-reactivity between pencillins and cephalosporins ranges from 5% to 10%. Even though some patients with a history of penicillin allergy may tolerate cephalosporins, patients with a history of anaphylaxis to penicillin should not receive cephalosporins. 

Anne S, Reisman RE. Risk of administering cephalosporin antibiotics to patients with histories of penicilhn allergy. Ann Allergy Asthma Inununol... 

If a patient has a mild, delayed allergy to penicillin, first-generation cephalosporins (such as cefazolin) are effective alternatives, but they should be avoided in patients with a history of immediate-type hypersensitivity reactions to penicillins (see Table 109-6). The potential for a true immediate-type allergy should be assessed carefully, and a penicillin skin test should be conducted before giving antibiotic treatment to any patient claiming an allergy. 

In man, allergic reactions have been in reported in patients with no prior history of penicillin allergy, leading to the assumption that cephalosporins may be immunogenic by themselves (Kaplan and Weinstein 1967 Abraham et al. 1968 a, b Molthan 1969 Saleh and Tischler 1974). 

Cross-reactivities between antibodies to cephalosporins and penicillins have been observed in experimental animals (Brandriss et al. 1965 Batchelor et al. 1966 Gralnick and McGinnis 1967 Tadokoro et al. 1976) and in man (Abraham et al. 1968 b Grieco 1967 Stemberger et al. 1971 Delafuente et al. 1979). Among 701 patients with a history of penicillin allergy, 57 (8.1%) experienced an... 

Immunologic Of 85 patients with a history of penicillin allergy and positive penicillin skin tests 5 (6%) had an adverse drug reaction to a cephalosporin compared with 5 (0.7%) of 726 patients with a history of penicillin allergy but negative penidllin skin tests [7. Presumed IgE-mediated adverse reactions to the cephalosporins occurred in 2 (2%) of the former compared with only 1 (0.1%) of the latter. 

A retrospective review of all total hip and knee arthroplasties completed from 2007 to 2010 at a Canadian university hospital evaluated the cross-reactivity of cefazolin in patients who experienced a history of a non-IgE-mediated reaction to penicillin. The prevalence of penicillin allergy was 9.9%, and subsequent administration of cefazolin in these patients produced zero adverse reactions. This report adds to the evidence that penicillin/cephalosporin crossreactivity is generally overestimated [53 , 54 ]. 

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