Many patients do not receivecephalosporins due to their penicillin allergy; most of these patients will not have an allergic response and canreceive these drugs safely
Many patients do not receivecephalosporins due to their penicillin allergy; most of these patients will not have an allergic response and canreceive these drugs safely: Excerpt from Avoiding Common Pediatric Errors
Author:
Dorothy Chen, MD
What to Do - Gather Appropriate Data
Many patients do not receive cephalosporins due to their penicillin allergy;
most of these patients will not have an allergic response and can receive these
drugs safely.
Penicillin is a commonly used antibiotic in pediatrics. The penicillins
consist of a β-lactam ring and a side chain. The β-lactam ring provides the
antimicrobial activity by inhibiting the bacterial penicillin-binding proteins.
The side chains determine the spectrum of activity. Penicillin is often prescribed for common childhood infections, such as otitis media and sinusitis.
Approximately 1% to 10% of patients who take β-lactam antibiotics report
adverse reactions. These reactions are often assumed to be allergic reactions
that limit their future use.
Adverse reactions can include a wide spectrum of symptoms: nausea,
emesis, diarrhea, rash, or anaphylaxis. Many of these are nonimmunologic
effects. It is important to elicit the details of the symptoms to differentiate
between side effects and a true immunoglobulin (Ig)E-mediated reaction.
Type I allergic reactions are IgE-mediated and present with signs ranging
from urticaria to anaphylaxis. They typically occur from 1 to 72 hours after
ingestion of the medication. Skin testing can be performed to confirm IgEmediated reactions and is approximately 60% predictive of a reaction. Type
II (IgG), III (IgG or IgM-mediated), and IV reactions to penicillin do occur,
but these are not allergic (IgE-mediated) reactions.
Penicillins and cephalosporins both have a β-lactam ring. However,
penicillins have a 5-membered thiazolidine ring and cephalosporins have a
6-membered dihydrothiazine ring. When these antibiotics degrade, their
structures are quite different. Penicillins preserve the thiazolidine ring,
whereas cephalosporins degrade both the β-lactam and dihydrothiazine
rings,thecross-reactivitybetweenthe β-lactamrings isminimal.TheAmerican Academy of Pediatrics supports cephalosporin use in patients with non-
IgE mediated reactions to penicillin.
Skin rashes are the most common reaction to cephalosporins and occur
in 1% to 3% of patients. Anaphylaxis is a rare reaction. In penicillin-allergic
patients, a reaction to cephalosporins can be a primary cephalosporin reaction, and thus their concordant reactions can be a coincidence. Many studies
have researched the effect of cephalosporin in penicillin-allergic patients.
The use of the term allergic varies, so the studies do not focus solely on
IgE-mediated reactions. The cross-reactivity between cephalosporins and
penicillin reactions depends on the specific generation of cephalosporin.
Caution should be used when administering a cephalosporin, such as
cefoxitin, which has a similar 7-position side chain on the β-lactam ring, to a
patient with a severe IgE-mediated reaction to penicillin. However, evidence
supports the American Academy of Pediatrics' recommendation to give ceftriaxone to patients with non-IgE mediated reactions to penicillin. A careful
history of the prior "reaction" to penicillin remains the most important determinant in prescribing other classes of antibiotics.
Suggested Readings
Malik ZA, Litman N. The penicillins. Pediatr Rev. 2006;27(12):471–473.
Pichichero ME. A review of evidence supporting the American Academy of Pediatrics Rec
ommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pe
diatrics. 2005;115(4):1048–1057.
Ponvert C, Le Clainche L, de Blic J, et al. Allergy to B-lactam antibiotics in children. Pediatrics.
1999;104(4):e45.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
More About Penicillin allergy
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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