Is There Cross-Reactivity Between Penicillins and Cephalosporins? - 17/08/11
, Judith L. Kinman, MA b, Warren B. Bilker, PhD b, d, Maximilian Herlim b, David J. Margolis, MD, PhD b, d, e, Ebbing Lautenbach, MD, MPH, MSCE b, d, f, Sean Hennessy, PharmD, PhD b, c, d, Brian L. Strom, MD, MPH b, c, d
Requests for reprints should be addressed to Andrea J. Apter, MD, MSc, 829 Gates Building, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104.Abstract |
Background |
We sought to determine the risk of an allergic reaction to a cephalosporin exposure in those with prior penicillin reactions.
Methods |
We conducted a retrospective cohort study using the United Kingdom General Practice Research Database. We selected all patients receiving a prescription for penicillin followed by a prescription for a cephalosporin and identified allergic-like events within 30 days after each prescription. Allergic events were defined by 2 sets of codes: 1 more restrictive, 1 more inclusive. Comparison was made with a population of patients receiving a prescription for a penicillin followed by a prescription for a sulfonamide antibiotic.
Results |
A total of 3 375 162 patients received a penicillin; 506 679 (15%) received a subsequent cephalosporin. Among patients receiving a penicillin followed by a cephalosporin, the unadjusted risk ratio of an allergic-like event for those who had a prior event, compared with those who had no such prior event, narrowly defined, was 10.1 (confidence interval 7.4-13.8). The absolute risk of anaphylaxis after a cephalosporin was less than 0.001%. The unadjusted risk ratio for sulfonamide antibiotic, rather than cephalosporin after penicillin allergic-like events was 7.2 (confidence interval 3.8-13.5).
Conclusion |
Patients with allergic-like events after penicillin had a markedly increased risk of events after either subsequent cephalosporins or sulfonamide antibiotics. Cross-reactivity is not an adequate explanation for this increased risk, and the risk of anaphylaxis is very low. Thus, our data indicate that cephalosporins can be considered for patients with penicillin allergy.
Le texte complet de cet article est disponible en PDF.Keywords : Antibiotic allergy, Adverse drug reaction, Drug hypersensitivity, Penicillin, Cephalosporin
Plan
| Support was provided by the Agency for Healthcare Research and Quality Centers for Education and Research on Therapeutics Cooperative Agreement (grant HS10399) and the National Heart, Lung, and Blood Institute (HL K23 04337, Dr. Apter). |
Vol 119 - N° 4
P. 354.e11-354.e19 - avril 2006 Retour au numéro
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