4: Is it safe to administer cefazolin in penicillin-allergic patients?

Depth of Anesthesia

We investigate the claim that an alternative antibiotic to cephalosporins (e.g., cefazolin) should be selected for penicillin-allergic patients in the perioperative setting.

Claim 1. Alternative antibiotics may be as efficacious in preventing surgical site infections

Claim 2. Cephalosporins (e.g., cefazolin) may be unsafe due to cross-reactivity.

Claim 3. Administering cephalosporins (e.g., cefazolin) may be against the standard of care.

My guest this week is Dr. Matthew Vanneman, an attending cardiothoracic anesthesiologist at the Massachusetts General Hospital.

Full show notes available at depthofanesthesia.com.

Connect with us @DepthAnesthesia on Twitter or [e-mail].

Thanks for listening! Please rate us on iTunes and share with your colleagues.

Music by Stephen Campbell, MD.

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References

Beltran RJ, Kako H, Chovanec T, Ramesh A, Bissonnette B, Tobias JD. Penicillin allergy and surgical prophylaxis: cephalo- sporin cross-reactivity risk in a pediatric tertiary care center. J Pediatr Surg. 2015;50:856–859.

Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES. The impact of a reported penicillin allergy on surgical site infec- tion risk. Clin Infect Dis. 2018;66:329–336.

Blumenthal KG et al. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: Population based matched cohort study. BMJ 2018 Jun 27; 361:k2400.

Jeffres M, Hall-Lipsy E, King ST, Cleary J. Systematic Review of Professional Liability when Prescribing Β-Lactams for Patients with a Known Penicillin Allergy. Open Forum Infect Dis. 2017;4(Suppl 1):S341. Published 2017 Oct 4. doi:10.1093/ofid/ofx163.812

Macy E, Contreras R. Adverse reactions associated with oral and parenteral use of cephalosporins: a retrospective population-based analysis. J Allergy Clin Immunol 2015;135:745-752.e745.

Petz LD. Immunologic reactions of humans to cephalosporins. Postgrad Med J. 1971;47:Suppl:64-9.

Petz LD. Immunologic cross-reactivity between penicillins and cephalosporins: a review. J Infect Dis 1978;137:S74-9.

Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cepha- losporin antibiotics for penicillin-allergic patients. Pediatrics. 2005;115:1048–1057.

Zagursky RJ, Pichichero ME. Cross-reactivity in β-lactam allergy. J Allergy Clin Immunol Pract. 2018;6:72–81.e1.

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