Cephalosporins hypersensitivity

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). 

The cephalosporins generally cause few side effects. Thrombophlebitis occurs as a result of intravenous administration of all cephalosporins. Hypersensitivity reactions related to the cephalosporins are the most common side effects observed, hut these are less common than found with the penicillins. 

Penicillins are contraindicated in patients witii a history of hypersensitivity to penicillin or die cephalosporins. 

The most common adverse reactions seen with administration of the cephalosporins are gastrointestinal disturbances, such as nausea, vomiting, and diarrhea Hypersensitivity (allergic) reactions may occur with administration of the cephalosporins and range from mild to life threatening. Mild hypersensitivity reactions include pruritus, urticaria, and skin rashes. More serious hypersensitivity reactions include S teveils-Johnson syndrome (fever, cough, muscular aches and... 

For penicillin-allergic (nonanaphylactoid type) patients cefazolin 6 g/24 hours IV in 3 equally divided doses 6 IB Consider skin testing for oxacillin-susceptible staphylococci and questionable history of immediate-type hypersensitivity to penicillin cephalosporins should be avoided in patients with anaphylactoid-type hypersensitivity to P-lactams vancomycin should be used in these cases ... 

If a patient has a mild, delayed allergy to penicillin, first-generation cephalosporins are effective alternatives but should be avoided in patients with an immediate-type hypersensitivity reaction. 

In patients allergic to penicillin, a macrolide such as erythromycin or a first-generation cephalosporin such as cephalexin (if the reaction is nonimmunoglobulin E-mediated hypersensitivity) can be used. Newer mac-rolides such as azithromycin and clarithromycin are as effective as erythromycin and cause fewer GI adverse effects. 

Nonimmediate-type hypersensitivity /J-Lactamase-stable cephalosporin. 

Antibiotics Cephalosporins Chloramphenicol Neomycin Sulfathiazole Spiramycin Quinolones Tetracyclines Hypersensitivity Anaphylaxis, urticaria, rash, granulocytopenia Rash, dermatitis, urticaria Dermal exposure-rash, dermatitis Rash, dermatitis, urticaria Rash, dermatitis, urticaria Photosensitivity Photosensitivity, anaphylaxis, asthma, dermatitis... 

Cross-allergenicity with cephalosporins Individuals with a history of penicillin hypersensitivity have experienced severe reactions when treated with a cephalosporin. The incidence of cross-allergenicity between penicillins and cephalosporins is estimated to range from 5% to 16% however, it is possible the incidence is much lower, possibly 3% to 7%. 

Hypersensitivity reactions Reactions range from mild to life-threatening. Before therapy is instituted, inquire about previous hypersensitivity reactions to cephalosporins and penicillins. 

Hypersensitivity reactions Make careful inquiry for a history of hypersensitivity reactions. Monitor patients who have had immediate hypersensitivity reactions to penicillins or cephalosporins. If an allergic reaction occurs, discontinue the drug and institute supportive treatment. Cross-sensitivity with other penicillins or -lactam antibiotics is rare. 

Contraindications History of anaphylactic reaction to penicillins or hypersensitivity to cephalosporins... 

Contraindications Anaphylactic reaction to penicillins, history of hypersensitivity to cephalosporins or any one of its components. 

Contraindications Hypersensitivity to any penicillin, cephalosporins, or beta-lacta-mase inhibitors... 

Adverse reactions to cefuroxime have been generally mild and transient in nature. As with other cephalosporins there have been rare reports of erythema multiforme, Steven-Johnson syndrome, toxic epidermal necrolysis (exanthematic necrolysis) and hypersensitivity reactions including skin rashes, urticaria, pruritus, drug fever, serum sickness and very rarely anaphylaxis. 

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. 

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