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Choice of antibiotics in penicillin-allergic hospitalized patients

Kimberly G Blumenthal, MD, MSc
Roland Solensky, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


Penicillin allergy is the most common drug allergy and is reported in up to 15 percent of hospitalized patients [1]. A frequent clinical question is whether these patients can safely receive the structurally related cephalosporins or carbapenems (monobactams [ie, aztreonam] are not cross-reactive with penicillins and can be safely given to penicillin-allergic patients). This topic will present an approach to determining whether a patient with reported penicillin allergy can be treated with penicillins or related beta-lactam antibiotics, with or without access to allergy consultation. It is focused on the hospitalized patient but applies to ambulatory patients as well. The detailed allergy evaluation of a patient with past penicillin reaction based upon penicillin skin testing and studies of cross-reactivity among beta-lactam antibiotics are reviewed elsewhere.

(See "Allergy evaluation for immediate penicillin allergy: Skin test-based diagnostic strategies and cross-reactivity with other beta-lactam antibiotics".)

Penicillin allergy (immediate and delayed), penicillin skin testing techniques, and rapid drug desensitization are reviewed in more detail separately:

(See "Penicillin allergy: Immediate reactions".)

(See "Penicillin allergy: Delayed hypersensitivity reactions".)


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Literature review current through: May 2017. | This topic last updated: May 31, 2017.
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