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Cephalosporin-allergic patients: Subsequent use of cephalosporins and related antibiotics

Antonino Romano, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


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".)


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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Literature review current through: Nov 2017. | This topic last updated: Oct 16, 2014.
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