Cephalosporin-allergic patients: Subsequent use of cephalosporins and related antibiotics
- Antonino Romano, MD
Antonino Romano, MD
- Professor of Medicine
- Catholic University of the Sacred Heart
- Presidio Columbus, Rome, Italy
Cephalosporins are commonly-used antibiotics that can cause a variety of hypersensitivity reactions. The reactions can be broadly classified as follows:
●Immediate reactions are reactions that develop within one hour of administration. These are usually type I, immunoglobulin E (IgE)-mediated reactions and are characterized by urticaria, angioedema, bronchospasm, and/or hypotension (table 1).
●Nonimmediate reactions are reactions that develop >1 hour of administration, often after several hours or days. Common delayed reactions include maculopapular rashes and urticarial eruptions. Rare types of delayed reactions include serum sickness-like reactions, drug fever, and drug-induced hypersensitivity syndrome.
Patients with past reactions to a specific cephalosporin may require subsequent treatment with a different cephalosporin or a related antibiotic, such as a penicillin, carbapenem, or monobactam. Approaches to these different clinical scenarios will be presented here. The clinical manifestations, pathogenesis, and diagnosis of different types of cephalosporin-hypersensitivity reactions are reviewed separately. (See "Cephalosporin allergy: Clinical manifestations and diagnosis".)
PAST IMMEDIATE REACTIONS
Patients with past immediate reactions to cephalosporins who require subsequent use of other cephalosporins or penicillins should be evaluated by an allergy specialist. The purpose of this evaluation, which usually involves skin testing, is to determine what other drugs may be safely administered to that patient. Most patients will be able to tolerate other cephalosporins and/or penicillins.
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- PAST IMMEDIATE REACTIONS
- Use of other cephalosporins
- Use of the same cephalosporin that caused a previous reaction
- Use of penicillins
- Use of carbapenems and monobactams
- PAST NONIMMEDIATE REACTIONS
- Past maculopapular rash
- Delayed-onset urticaria/angioedema
- Past serum sickness
- USE OF CEPHALOSPORINS IN PATIENTS ALLERGIC TO PENICILLINS
- SUMMARY AND RECOMMENDATIONS
- Immediate reactions
- Nonimmediate reactions