Cephalosporins cross-reactivity with penicillins

The generic nature of the antiserum was shown by good relative cross-reactivities with penicillin type (3-lactam antibiotics such as amoxicillin (50%), ampicillin (47%), and penicillin V (145%), and a lower response to the isoxazolyl penicillins such as oxacillin, cloxacillin, and dicloxacillin. No cross-reactivity was obtained for cephalosporin type p-lactam antibiotics (cephapirin), cloramphenicol, or fluoroquinolones (enrofloxacin and ciprofloxacin). 

First-generation cephalosporin prototype bactericidal beta-lactam inhibitor of cell wall synthesis. Active against gram-positive cocci, E coli, K pneumoniae. but does not enter CSF. Tox potential allergy partial cross-reactivity with penicillins. 

Adverse effects Aztreonam is relatively nontoxic, but it may cause phlebitis, skin rash, and occasionally, abnormal liver function tests. Aztreonam has a low immunogenic potential and shows little cross-reactivity with antibodies induced by other p-lac-tams. Thus aztreonam may offer a safe alternative for treating patients allergic to penicillins and/or cephalosporins. 

The patient s serum was tested for antibodies against five penicillins and 30 different cephems (that is all types of cephalosporins), using protocols to detect drug adsorption as well as immune-complex mechanisms. His serum contained an IgM antibody that formed immune complexes with 10 of the 30 cephems. The 10 drugs were classified as oxime-type cephalosporins, that is they had a common structural formula at the C7 position on 7-aminocephalosporinic acid. This antibody did not show any cross-reactivity with five kinds of penicillins (ampiciUin, aspoxicillin, carbenicil-lin, piperacillin, sulbeniciUin). The authors asked a difficult question Why did anaphylactic shock accompany acute hemolysis Their answer was that the complex of ceftizoxime with IgM anti-ceftizoxime might act like anti-A or anti-B. This hypothesis will surely be further tested. In the meantime, it would be wise not to use the newer cephalosporins too freely. 

E Because JK has experienced anaphylaxis to amoxicillin, prescription of any type of penicillin or cephalosporin should be avoided. Cross-reactivity between penicillins and cephalosporins is incomplete, but with a history of anaphylaxis to penicillins, cephalosporins should not be prescribed. Clindamycin would be an appropriate alternative to use to treat the cellulitis. 

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. 

Mine Y, Nishida M, Goto S, Kuwahara S (1970) Cefazolin, a new semisynthetic cephalosporin antibiotic. IV. Antigenicity of cefazolin and its cross reactivity with benzylpenicillin, ampicillin and cephaloridine. J Antibiot 23 195 Minikin WP, Lynch PJ (1969) Allergic reactions to penicillin in milk. JAMA 209 1089... 

The cephalosporins generally cause few side effects (80,132,219—221). Thrombophlebitis occurs as a result of intravenous administration of all cephalosporins. Hypersensitivity reactions related to the cephalosporins are the most common side effects observed, but these are less common than found with the penicillins. Clinically only about 5—10% of patients with allergic reactions to the penicillins manifest the same reactions to the cephalosporins, and data would contradict any tme cross-reactivity to cephalosporins in patients who have previously reacted to penicillin (80,132,219). 

It has also been reported that patients with allergic-like events after penicillin treatment have had a markedly risk of events after subsequent cephalosporin antibiotics. Cross-reactivity is not an adequate explanation for this increased risk and the data obtained indicate that cephalosporins can be considered for patients with penicillin allergy <2006MI354.ell>. Comparisons of parenteral broad-spectrum cephalosporins have been tested against bacteria isolated from pediatric patients. The results have indicated that cefepime has been the most broad-spectrum cephalosporin analyzed and it is a very potent alternative for the treatment of contemporary pediatric infections in North America <2007MI109>. The historical safety of the most commonly used oral cephalosporins has been reviewed <2007MIS67>. The antimicrobial spectrum and in vitro potency of the most frequently prescribed orally administered cephalosporins (cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil and cephalexin has also been reviewed <2007MIS5>. 

As with the penicillins, hypersensitivity reactions are the most common systemic adverse events caused by cephalosporins. Maculopapular rash, urticaria, fever, bron-chospasm,and anaphylaxis have been associated with the use of cephalosporins.Because the molecular structure of the penicillins and the first-generation cephalosporins are similar, there is a risk in patients who are aUergic to penicillin to manifest aUergic cross-reactions when prescribed any of this gronp of cephalosporins. In contrast, the risk of cross-reactivity between the penicUUns and the second-, third-, and fonrth-generation cephalosporins has been overestimated, and patients with a previons aUergic... 

Moss RB, McClelland E, Williams RR, Hilman BC, Rubio T, Adkinson NF. Evaluation of the immunologic cross-reactivity of aztreonam in patients with cystic fibrosis who are allergic to penicillin and/or cephalosporin antibiotics. Rev Infect Dis 1991 13(Suppl 7) S598-607. 

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. 

Each of the dmgs listed has activity against some gram-negative bacilli. All penicillins should be avoided in patients with a history of allergic reactions to any individual penicillin drug. Cephalosporins should also be avoided in patients who have had anaphylaxis or other severe hypersensitivity reactions following use of a penicillin. There is no cross-reactivity between the penicillins and aztreonam. The answer is (B). 

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... 

A review of the use of cephalosporins in children with anaphylactic reactions to penicillins conclnded that there were no published case reports of anaphylaxis to these antibiotics in the assessed group and, in any case, anaphylaxis to cephalosporins was extremely rare in children. A prospective study of over 1,000 children with suspected immediate reactions to cephalosporins and/or penicillins showed that 58 % were skin or challenge test positive to a p-lactam with 94.4 % positive to penicillins and 35 % positive to cephalosporins. Approximately one-third of penicillin-allergic children cross-reacted with acephalosporin and those allergic to a cephalosporin showed an 84 % frequency of reactions to penicillins. Crossreactivity between cephalosporins was lower than CTOss-reactivity observed between cephalosporins... 

The question of tolerability of penicillins, monobactams, and carbapenems in patients with IgE hypersensitivity to cephalosporins was recently assessed in 98 subjects by serum IgE antibody assays, challenge tests, and skin testing with penicillin reagents, aztreonam, imipenem-cilastatin, and meropenem. Approximately 25 % of cephalosporin-allergic subjects were positive to penicillins, while 3.1,2, and 1 % showed positive results to aztreonam, imipenem, and meropenem, respectively. A reaction to a cephalosporin with a similar or identical side chain to penicillin was a sigifificant predictor of cross-reactivity. For skin testing, the following concentrations were used ampicillin and amoxicillin 1 and 20 mg/ml cephalosporins 2 mg/ml aztreonam 2 mg/ml imipenem-cilastatin 0.5 mg/ml and meropenem 1 mg/ml. 

Immune cross-reactivity of benzylpenicillin and ceph-alothin was reported.23 cross-allergenicity to penicillins and cephalorsporins was noted.23 in contrast, in a study on the allergenicity and toxicity of cephaloridlne and ceph-alothin, no cross-allergy with the penicillins was observed.27 An orally effective cephalosporin, e.. cephalexin, as well as oral penicillins, would appear to have greatly less sensitizing potential than those given by injection. 

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