Allergy, penicillin

Blanca M, Mayorga C, Torres MJ, Reche M, Moya MC, Rodriguez JL, Romano A, Juarez C Clinical evaluation of Pharmacia CAP System RAST FEIA amoxicilloyl and benzylpenicilloyl in patients with penicillin allergy. Allergy 2001 56 862-870. 

The health care professional is faced with a difficult task when approaching a patient who claims a history of penicillin allergy. While as many as 12% of hospitalized patients state that... 

Perioperative prophylaxis Bowel decontamination Donor culture results Penicillin allergy vancomycin... 

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. 

As such, patients with penicillin allergies should be treated with a first-generation cephalosporin (if non-type I allergy), a macrolide/azalide, or clindamycin. Recurrent infections caused by reinfection, poor adherence to therapy, or true penicillin failure can be treated with amoxicillin-clavulanate, clindamycin, or penicillin G benzathine.45... 

Cephalexin 250-500 mg 4 times daily 25-50 mg/kg per day in 4 doses 10 days Consider in penicillin allergy (if non-type I reaction)... 

Because GAS historically has been the primary causative organism, penicillin has been the mainstay of therapy. O However, the incidence ofS. aureus impetigo is increasing, so oral penicillinase-stable penicillins or first-generation cephalosporins are now preferred.3 Erythromycin is an alternative choice when penicillin allergy is a concern. Topical mupirocin may be used alone when there are few lesions.3... 

The most effective agent for the treatment (and prophylaxis) of human and animal bite-wound infections is amoxicillin-clavulanate. Alternatives for patients with significant penicillin allergies include either a fluoroquinolone or TMP-SMX in combination with clindamycin. Doxycycline also may be prescribed. The durations of prophylaxis and treatment generally are 3 to 5 and 10 to 14 days, respectively.3... 

Alternatives In non-pregnant patients with a penicillin allergy, alternative regimens include doxycycline 100 mg orally two times daily for 4 weeks or tetracycline 500 mg orally four times daily for 4 weeks. 

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. 

The Jarisch-Herxheimer reaction should not be confused with penicillin allergy. Most reactions can be managed symptomatically with analgesics, antipyretics, and rest. 

Serious infections should be treated intravenously with a penicillinase-resistant penicillin (nafcillin) or first-generation cephalosporin (cefazolin). Patients with penicillin allergies should be treated with vancomycin or clindamycin. 

Hysterectomy Enteric gram-negative bacilli, anaerobes, group B streptococci, enterococci Vaginal Cefazolin 1 g x l Abdominal Cefotetan 1 g x 1 or cefazolin 1 g x 1 Metronidazole 1 g IV x 1 is recommended alternative for penicillin allergy IA... 

Craniotomy S. aureus, 5. epidermidis Cefazolin 1 g x 1 or cefotaxime 1 g x 1 Trimethoprim-sulfamethoxazole (160/800 mg) IV x 1 can be substituted for patients with penicillin allergy IA... 

Josephson, A.S., Penicillin allergy apublic health perspective, J. Allergy Clin. Immunol., 113, 605, 2004. 

Ahlstedt, S. and Kristofferson, A., Immune mechanisms for induction of penicillin allergy,... 

Qiao, H.L., Yang, J., and Zhang, Y.W., Serum specific IgE levels and FceRip genetic polymorphism in patients with penicillin allergy, Allergy, 59, 1326, 2004. 

Batchelor, F.R., Dewdney, J.M. and Cazzard, D. (1965). Penicillin allergy the formation of penicilloyl determinant. Nature (London) 206 362-364. 

Penicillins and cephalosporins bind irreversibly to serum albumin. It has been shown that drug-protein conjugates result from the aminolysis of the /3-lactam bond by the e-amino group of lysine residues in the protein (Fig. 5.1, Pathway e). The bound penicilloyl group appears to be the major antigenic determinant of penicillin allergy [145-148],... 

C. W. Parker, J. Shapiro, M. Kern, H. N. Eisen, Hypersensitivity to Penicillenic Acid Derivatives in Human Beings with Penicillin Allergy , J. Exp. Med. 1962, 115, 821-838. 

Amoxicillin was prescribed and dispensed to a patient with a Penicillin allergy. The front of the chart was not marked for an allergy and the problem list showing the allergy was covered with a misfiled document. The pharmacy software program does not screen for allergies and the pharmacy profile was not marked with any allergies. 

An urticarial rash, not representing a true penicillin allergy, occasionally occurs with ampicillin (9%). Typically, the rash appears 7 to 10 days after the start of oral ampicillin therapy and remains for a few days to a week after drug discontinuance. In most cases, the rash is maculopapular, pruritic, and generalized. 

Padovan, E. et al. (1997) Penicilloyl peptides are recognized as Tcell antigenic determinants in penicillin allergy. European Journal of Immunology, 111 (6), 1303-1307. 

Because of cross-reactions between cephalosporins and penicillins, caution should be used when prescribing cephalosporins to patients with penicillin allergy. If a patient had anaphylaxis, angioedema, or urticaria fol-... 

Imipenem-cilastatin is one of the drugs of first choice for the empirical therapy of many polymicrobial pulmonary, intraabdominal, and soft tissue infections. The notable adverse effect of imipenem-cilastatin is seizures affecting 1% of patients. Risk factors for seizures are old age, head trauma, previous seizure disorder, cerebrovascular accident, and renal failure. Among patients with a history of penicillin allergy, 10% are cross-sensitive to imipenem-cilastatin. 

Salkind AR, Cuddy PG, and Foxworth JW. Is this patient allergic to penicillin An evidence-based analysis of the likelihood of penicillin allergy. 

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