Auszug DocAlert: Cephalosporins Often Safe in PCN-Allergic Patients
Clinical question
What is the evidence regarding the use of cephalosporins in
patients with penicillin allergy?
Bottom line
The risk of cross-reactivity between penicillin and
cephalosporins has been overestimated for second- and third-generation
drugs. It is only a significant risk in first-generation
cephalosporins that have a similar side chain to penicillin (cephalothin,
cephalexin, cefadroxil, and cefazolin). With appropriate
monitoring physicians could consider using second- and third-generation
cephalosporins in these patients. (LOE = 2a)
Reference
Pichichero ME. Cephalosporins can be prescribed safely for
penicillin-allergic patients. J Fam Pract 2006; 55:106-12.
Study design
Systematic review
Setting
Various (meta-analysis)
Synopsis
The author did a comprehensive search of MEDLINE and EMBASE to
identify the 101 articles that were used as the basis for this
systematic review. The overall rate of rash is approximately 2%.
Anaphylaxis is very rare, with a risk between 0.1% and 0.0001%.
Physicians often worry about cross-reactivity between penicillins
and cephalosporins, but this only seems to apply to first-generation
cephalosporins such as cephalothin, cephaloridine, cephalexin,
cefadroxil, or cefazolin. No increase in the risk of an allergic
reaction is seen in second- and third-generation cephalosporins,
including cefprozil, cefuroxime, ceftazidime, cefpodoxime, and
ceftriaxone. The author speculates that this is because of
similar side chains in the chemical structure between penicillins
and first-generation (but not second- or third-generation)
cephalosporins. Patients with a previous IgE mediated reaction to
penicillin (eg, wheezing, angioedema, urticaria, laryngeal edema,
or anaphylaxis) should not use first-generation cephalosporins
but may be able to safely take second- and third-generation
cephalosporins.
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Ausführlicher SMF-Artikel zum selben Thema: SMF: 2006;6:319-326: Unverträglichkeit von Betalaktam-Antibiotika: praktische Probleme und ihre Ursache