Do not avoid antibiotic use in patients with serious infections because of theoretical limitations

Author: Yolanda Lewis-Ragland, MD

What to Do - Take Action

The American Academy of Pediatrician's evidence-based guidelines endorse the use of cephalosporin antibiotics for patients with reported allergies to penicillin for the treatment of acute bacterial sinusitis and acute otitis media. Manyphysicians,however,remainreluctanttoprescribesuchagentsbecause of a fear of cross-reactivity between the two drug classes. Although these concerns are understandable, a lack of consistent data regarding exactly what constitutes an initial penicillin-allergic reaction and subsequent cross- sensitivity to cephalosporins may possibly prevent patients from receiving optimal antibiotic therapy.

This topic is one of great importance because true allergic reactions to penicillin can be extremely varied. Allergic responses occurring with a penicillin allergy range from annoying rashes to life-threatening reactions, such as difficulty anaphylaxis.

Signs and Symptoms of Penicillin Allergy

Common signs and symptoms of penicillin allergy include:
• Rash
• Hives
• Itchy eyes
• Swollen lips, tongue, or face (angioedema). The most serious allergic reaction to penicillin, however, is anaphylaxis, which has a high mortality if untreated. Anaphylactic reactions develop immediately after penicillin exposure in highly sensitized people and cause bronchoconstriction, hypotension, and loss of consciousness. Other serious signs and symptoms include:

• Wheezing
• Lightheadedness
• Slurred speech
• Rapid or weak pulse
• Cyanosis, including circumoral and nail beds
• Diarrhea
• Nausea and vomiting.

Are Cephalosporins a Real Threat?

Cephalosporin antibiotics are important in infectious diseases and, like penicillins, are widely prescribed for common infections such as bronchitis, otitis media,pneumonia,andcellulitis.Theyarealsoadministeredasfirst-lineprophylaxis for many types of surgical procedures. A relative contraindication to these agents has been a history of allergy to penicillin. In this situation, manyclinicianswouldselectadifferentclassofantibiotic,suchasamacrolide or vancomycin. However, the emergence of antimicrobial-resistant organisms demands that the selection of antibiotics be made only after careful evaluation.

Inlight ofthis, investigatorshaveperformedextensive studieswith both experimental and clinical trials. The results indicate that if a cephalosporin with a side chain that is different from the penicillin is used. The risk of suffering an allergic reaction by administering cephalosporins to penicillin- allergic patients is very low.

Suggested Readings

Mayo Foundation for Medical Education and Research. Penicillin Allergy. December 22, 2005. Available at: www.cnn.com/HEALTH/library/DS/00620.html. Accessed November 14, 2007.
Novalbos A, Sastre J, Cuesta J, et al. Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins. Clin Exp Allergy. 2001;31(3):438–443.
Romano A, Gu´eant-Rodriquez R-M, Viola M, et al. Summaries for patients. Cephalosporin allergy in patients with penicillin allergy. Ann Intern Med. 2004;141(1):I48.

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.

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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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