Cross-reactivity cephalosporins

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). 

Minimal cross-reactivity between aztreonam and penicillins and cephalosporins aztreonam and aminoglycosides have been shown to be synergistic in vitro against most strains of P. aeruginosa, many strains of Enterobacteriaceae, and other gramnegative aerobic bacilli... 

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). 

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>. 

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. 

Ceftriaxone is a cephalosporin antibiotic. Consider using a different antibiotic if the person has a true penicillin allergy, as cephalosporins show cross-reactivity to penicillins in about 8% of people. 

Hypersensitivity to cephalosporins Risk of cross reactivity Adverse effects ... 

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... 

Cephalosporin analog elastase mechanism-based some cross-reactivity 161,000 M-is-i (48)... 

There is cross-allergy between all the various forms of penicillin, probably due in part to their common structure, and in part to the degradation products common to them all. Partial cross-allergy exists between penicillins and cephalosporins (a maximum of 10%) which is of particular concern when the reaction to either group of antimicrobials has been angioedema or anaphylactic shock. Carba-penems (meropenem and imipenem-cilastatin) and the monobactam aztreonam apparently have a much lower risk of cross-reactivity. 

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. 

Blanca M, Fernandez J, Miranda A, Terrados S, Torres MJ, Vega JM, Avila MJ, Perez E, Garcia JJ, Suau R. Cross-reactivity between penicillins and cephalosporins clinical and immnnologic stndies. J Allergy Clin Immunol 1989 83(2 Pt l) 381-5. 

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. 

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. 

Describe the cross-reactivity between penicillins and cephalosporins. 

ADVERSE REACTIONS Hypersensitivity reactions are the most common side effects of cephalosporins they are identical to those caused by the penicillins, perhaps related to their shared /3-lactam structure. Patients who are allergic to one drug class may manifest cross-reactivity to a member of the other class. There is no skin test that can reliably predict whether a patient will manifest an allergic reaction to the 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. 

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). 

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. 

Since their introduction to therapy, the question of allergic cross-reactivity between cephalosporins and penicillins has been raised, and continues to be raised for each of the new cephalosporin molecules introduced (Petz 1971 Pevny et al. 1973). Immunopathological reactions to cephalosporins have been reported and often confirmed by objective tests. It is, however, frequently difficult to assess whether such reactions are due to cross-reactivity on the basis of preexisting penicillin hypersensitivity or whether it is the manifestation of a de novo sensitization to cephalosporin. 

There is also a brief report on the development of delayed hypersensitivity reactions in guinea pigs to a cephalosporin-albumin conjugate (Lerner and Stan-DER 1973). Little work has been reported on the elicitation of contact reactions in guinea pigs by cephalothin. Neither de novo sensitization nor cross-reactivity in animals sensitized by benzylpenicillin were achieved by the Beecham s group (Batchelor et al. 1966 Dewdney 1977), while weak and irregular sensitization was reported by Schneierson et al. (1964). 

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... 

Table 9. Cross-reactivity between penicillins and cephalosporins in lymphocyte stimulation of penicillin-allergic patients ...

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... 

Petz LD (1978) Immunologic cross-reactivity between penicillins and cephalosporins a review. J Infect Dis 137 (Suppl) 74... 

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