ÎSkin testing with nonirritating concentrations of non–β-lactam antibiotics is not standardized. A negative skin test result does not
rule out the possibility of an immediate-type allergy. A positive skin test result suggests the presence of drug-specific IgE antibodies, but the predictive value is unknown. (D)
ÎGive non–β-lactam antibiotics to patients with a history of reactions to non–β-lactam antibiotics consistent with an IgE-mediated mechanism only if an alternate agent cannot be substituted and only via rapid induction of drug tolerance. (D)
ÎSulfonamide antibiotics rarely cause IgE-mediated reactions and more commonly result in delayed maculopapular rashes, particularly in HIV-positive patients. (C)
ÎThere is no evidence to suggest allergic cross-reactivity between sulfonamide antibiotics and nonantibiotic sulfonamides. (C)
ÎVancomycin rarely causes IgE-mediated reactions, but more than 50% of patients experience immediate cutaneous erythema, flushing, and pruritus (red man syndrome), which is the result of non–IgE-mediated histamine release. (C)
ÎPrevent red man syndrome reactions by slowing the rate of infusion and premedicating with histamine1
receptor antihistamines. (C)
ÎAminoglycosides rarely cause drug allergic reactions, including IgE- mediated systemic reactions. (C)
ÎIgE-mediated and non–IgE-mediated anaphylactic reactions have been reported with quinolones. > In vitro studies suggest a large extent of allergic cross-reactivity among quinolones, but there are no clinical studies to confirm this. (C)
Table 6. Nonirritating Concentrations of 15 Antibiotics
Antimicrobial Drug
Azithromycin Cefotaxime Cefuroxime Cefazolin
Ceſtazidime Ceſtriaxone Clindamycin Cotrimoxazole Erythromycin Gentamicin Levofloxacin Nafcillin
Ticarcillin Tobramycin Vancomycin
Full-strength Concentration
100 mg/mL 100 mg/mL 100 mg/mL 330 mg/mL 100 mg/mL 100 mg/mL 150 mg/mL 80 mg/mL 50 mg/mL 40 mg/mL 25 mg/mL 250 mg/mL 200 mg/mL 80 mg/2 mL 50 mg/mL
Dilution from Full Strength
10-4 10-1 10-1 10-1 10-1 10-1 10-1 10-2 10-3 10-1 10-3 10-4 10-1 10-1 10-4
Nonirritating Concentration
10 mcg/mL 10 mg/mL 10 mg/mL 33 mg/mL 10 mg/mL 10 mg/mL 15 mg/mL
800 mcg/mL 50 mcg/mL 4 mg/mL
25 mcg/mL 25 mcg/mL 20 mg/mL 4 mg/mL 5 mcg/mL
15
