P-lactam drugs

Reboud-Ravaux, M. Vergely, I. Maillard, J.-L. Favreau, C. Kobaiter, R. Joyeau, R. Wakselman, M. Prevention of some types of inflammatory damage using AA 231-1, a fluorinated P-lactam. Drugs Exp. Clin. Res. 1992, 13, 159-162. 

Suggest reasons for bacterial resistance to p-lactam drugs. 

Jemal, M. Ouyang, Z. Xia, Y.-Q. Powell, M.L. A Versatile System of High-Flow High Performance Liquid Chromatography with Tandem Mass Spectrometry for Rapid Direct-Injection Analysis of Plasma Samples for Quantitation of a p -Lactam Drug Candidate and its Open Ring Biotransformation Product, Rapid Commun. Mass Spectrom. 13(14), 1462-1471 (1999). 

In 2003 in the United States, 4,456,141 tests for residues in milk and other dairy products yielded 3246 (0.07%) positive results. Of these, 4,354,087 tests and 3207 positives (0.07%) were for P-lactam drugs.Of 66,124 tests for sulfonamides, 23 (0.03%) were positive. In the same year, of 3577 milk and cheese products tested by CFIA, none yielded positive results for AMDs or sulfonamides. The screening tests in use have good sensitivity and negative predictive values, but poor positive predictive values. Thus, a positive test on an individual cow does not necessarily indicate a bulk tank milk concentration exceeding the MRL (see Chapter 5 for further discussion). 

It seems prudent to skin test all patients with a history of allergy to a penicillin if, at the time, penicillin remains the indicated drug of choice. Skin testing should be carried out immediately before administration of the drug and repeated before any subsequent courses. Skin testing with penicillins or any other p-lactam is absolutely contraindicated in patients with a history of Stevens-Johnson or Lyell s syndrome (toxic epidermal necrolysis), exfoliative dermatitis, or other reactions where p-lactam drug administration is contraindicated. 

From Pham NH, Baldo BA. p-Lactam drug allergens Fine structural recognition patterns of cephalosporin-reactive IgE antibodies. J Mol Recognition 1996 9 287. Reprinted with permission from John WUey and Sons... 

Intradermal tests with delayed reading, patch tests, and occasionally prick tests provide the mainstay diagnostic procedures for the evaluation of delayed reactions to penicillins and other p-lactam drugs. 

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