Avoid other penicillins in true penicillin allergy. *For penicillins, chart only addresses cross-reactivity with cephalosporins. 2018.Įxcludes cephalosporins that have been discontinued or are rarely used (ex = cephalothin, cefamandole, cefoperazone) Penicillin, piperacillin, ampicillin, cephalexin, cefaclorĬeftibuten, ceftriaxone, cefotaxime, cefpodoxime, ceftazidime,Ĭefepime, ceftaroline, ceftolozane, cefiderocolĬefuroxime, ceftibuten, cefdinir, cefixime, ceftazidime,Ĭefuroxime, ceftibuten, ceftriaxone, cefotaxime, cefpodoxime,Ĭeftazidime, cefepime, ceftaroline, ceftolozane, cefiderocolĬefuroxime, ceftibuten, cefdinir, cefixime, ceftriaxone, cefotaxime,Ĭefpodoxime, ceftazidime, cefepime, ceftolozane, cefiderocolĬeftibuten, cefdinir, cefixime, ceftriaxone, cefotaxime,Ĭefpodoxime, cefepime, ceftaroline, CeftolozaneĬefdinir, cefixime, ceftriaxone, cefotaxime, cefpodoxime,Ĭefpodoxime, ceftazidime, cefepime, ceftaroline, cefiderocolĬefixime, ceftriaxone, cefotaxime, cefpodoxime, cefepime,Ĭefadroxil, cephalexin, cefprozil, cefaclorĪdapted from Zagursky RJ. Penicillin, piperacillin, amoxicillin, cefadroxil, cefprozil Similar R1/R2 side chains – low risk of cross-reactivityīut caution if history of life-threatening reaction Patients may experience an independent allergic reaction to a different β-lactam unrelated to cross-reactivity.Carbapenems and aztreonam have sufficiently dissimilar structures from penicillins/cephalosporins and are not expected to cross-react (exception = aztreonam with ceftazidime or cefiderocol).
#PENICILLIN CEPHALOSPORIN CROSS REACTIVITY 2016 UPDATE#
Prescriber Update 2-16 September 37(3): 44.Ģ.Herbert ME, Brewster GS, Lanctot-Herbert M.
Medsafe New Zealand Medicines and Medical Devices Safety Authority. Allergy test results are useful when positive, but a negative result does not adequately exclude allergy to the specific antibiotic.įor further more general advice on this topic, see this previous discussion posted on AIMED by Dr Kathryn Patchett, immunologist with Pathology North.ġ.Beta-lactam antibiotics and cross-reactivity.Cross-reactivity between penicillin and third-generation cephalosporins occurs in 2-3% of penicillin allergic patients (see risk stratification above).Other key points from the MedSafe paper include: The different degradation patterns of penicillins and cephalosporins contribute to differences in immunogenicity – penicillins break down to form stable penicilloyl moieties (amongst a range of other reactive intermediates) whereas the structural rings of cephalosporins fragment rapidly into degradation products that are much less immunogenic. Low and intermediate risk especially if a distant reaction – risk associated with third generation cephalosporin use can be assumed to be negligible.documented or convincing history of life threatening anaphylaxis – avoid betalactam use, desensitise or do a graded challenge with a third generation cephalosporin This is considered a reasonable approach to risk stratification: Prescribers must always attempt to accurately document the actual history of a patient’s penicillin reaction. Beta-lactam side-chain and ring structures and their potential immunogenicity are explained.
A frequent issue is deciding whether a patient with a “penicillin allergy” can safely be given a cephalosporin antibiotic – what is the real risk of cross reaction and is it much less for third generation agents such as ceftriaxone?Ī recent publicationin Prescriber Update from Medsafe New Zealand succinctly analyses cross-reactivity amongst beta-lactam antibiotics in the light of some interesting recent data.
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