Perioperative use and safety of cephalosporin antibiotics in patients with documented penicillin allergy

Approximately 9% of the US population reports a history of a penicillin allergy (PA).1 Cephalosporins, especially cefazolin, are often first-line perioperative antibiotics due to their effectiveness in preventing surgical-site infections caused by common gram-positive and gram-negative bacteria.2 In the perioperative setting, unnecessary avoidance of first-line cephalosporin antibiotics in patients with documented PA is associated with increased surgical-site infections.2 Growing evidence suggests that it may be safe to administer cefazolin and third- to fifth-generation cephalosporin antibiotics in patients with documented PA.3-5 Most patients with documented PA are likely not at increased risk for hypersensitivity to cefazolin or third- to fifth-generation cephalosporin antibiotics. [...]the true culprit of the HSRs was not identified because full allergy evaluations were not performed because of the retrospective nature of this study. In summary, these findings provide further evidence that standard administration of perioperative cephalosporin is safe in patients with a documented PA and provide support that published algorithms for BL antibiotic use in patients with documented PA are safe to adopt.Online Repository Penicillin/cephalosporin allergy history Perioperative reaction history Risk Antibiotic, Reaction Timing of documentation Antibiotics administered Other medications administered Symptoms Treatment Anaphylaxis High Penicillins, Anaphylaxis 5 mo before surgery AztreonamClindamycin GlycopyrollateLidocainePropofolRocuroniumRemifentanil FlushingHypotension DexamethasoneEpinephrineNo need for vasopressor support or intubation after case end Low Penicillins, Itching 11 mo before surgery Cefazolin CisatracuriumMidazolamPropofol BronchospasmHypotension DiphenhydraminePrednisoloneMethylprednisoloneEpinephrineNo need for vasopressor support or intubation after case end Low Penicillins, Rash 1 mo before surgery Clindamycin BupivicaineFentanylMidazolamPropofol BronchospasmRash HydrocortisoneFamotidineDiphenhydramineAlbuterolNo need for vasopressor support or intubation after case end Mild HSR High Penicillins, Anaphylaxis 15 mo before surgery None before reaction DexamethasoneFentanylLidocaineMidazolamPropofolRocuronium Hives TriamcinoloneDiphenhydramineNo need for vasopressor support or intubation after case end High Penicillins, Unknown 41 mo before surgery CiprofloxacinMetronidazole EtomidateFentanylLidocaineMidazolamOndansetronRocuroniumSuccinylchol