Treatment
ÎConsider penicillin skin testing, when available, before administration of cephalosporins in patients with a history of penicillin allergy. (E)
ÎPatients who have a history of a possible IgE-mediated reaction to penicillin, regardless of the severity of the reaction, may receive cephalosporins with minimal concern about an immediate reaction if skin test results for penicillin major and minor determinants are negative. (B)
ÎTreatment options for penicillin skin test-positive patients include
(1) administration of an alternate (non–β-lactam) antibiotic, (2) administration of cephalosporin via graded challenge, or (3) administration of cephalosporin via rapid induction of drug tolerance. (E)
ÎSkin testing to the cephalosporin followed by graded challenge appears to be a safe method for administration of some cephalosporins in penicillin-allergic patients. (B)
ÎIf penicillin and cephalosporin skin testing is unavailable, depending on the reaction history, cephalosporins may need to be given via graded challenge or rapid induction of drug tolerance. (E)
Penicillin Administration to Patients With a History of Cephalosporin Allergy
ÎEnsure patients allergic to amoxicillin avoid cephalosporins with identical R-group side chains (cefadroxil, cefprozil, cefatrizine) or receive them via rapid induction of drug tolerance. (C) Similarly, ensure patients allergic to ampicillin avoid cephalosporins and carbacephems with identical R-group side chains (cephalexin, cefaclor, cephradine, cephaloglycin, loracarbef) or receive them via rapid induction of drug tolerance. (C)
ÎFor patients with a history of an immediate-type reaction to a cephalosporin, conduct penicillin skin testing, if available, before treatment with penicillin. (E)
> If test results are negative, they may safely receive penicillins. (B)
> If test results are positive, use an alternate drug, or perform rapid penicillin induction of drug tolerance. (B)
> If penicillin skin testing is unavailable, administer penicillin via cautious graded challenge. (C)
12
