![]() ![]() While cephalothin was the most common cephalosporin to cause a reaction (9 of 128, 7%), five other patients reacted to a cephalosporin. Based on the theory of side chains being the culprit of cross-reactivity, only exposure to cephalothin should result in a positive skin test, as it is the only cephalosporin tested with a similar side chain to penicillin. The cephalosporins tested were cephalothin, cefamandole, cefuroxime, ceftriaxone, cefotaxime, and ceftazidime. performed cephalosporin skin tests on 128 patients with immediate hypersensitivity to a penicillin derivative. More recent studies challenge the idea of broad cross-reactivity between penicillin and cephalosporins. Beta-lactam avoidance has resulted in an increase in the use of secondary antibiotics (namely vancomycin and fluoroquinolones), and thus an increase in resistant infections, treatment failures, and cost. This over-generalization of cross-reactivity has resulted in the avoidance of all cephalosporins, not just cephalothin, in patients labeled as penicillin allergic. These inaugural studies led to the teaching that cross-reactivity between penicillins and cephalosporins ranges from 5-10%. Additional studies reported similar frequencies of cross-reactivity. Four of 51 patients (8%) with a penicillin allergy also had a reaction to cephalothin. Cross-reactivity between penicillin and cephalothin was first reported in 1966. In this article an experienced infectious diseases pharmacist discusses the importance of chemical structure side chains in considering when an allergy to a penicillin may translate into an allergy for a cephalosporin and vice versa.Ĭephalothin was the first cephalosporin marketed in 1964. The cross-reactivity between cephalosporins and penicillins is an important topic in medicine. ![]()
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