Cephalosporins can be given to penicillin-allergic patients who do not exhibit an anaphylactic response.
OBJECTIVE
To assess the risk of intraoperative allergic reactions to cephalosporins in patients who claim to be allergic to penicillin.


METHODS
Retrospective chart review.


METHODS
University-affiliated hospital.


METHODS
2,933 intraoperative anesthesia records of all adult orthopedic patients treated at our institution during a 14-month period (7/96-8/97) were reviewed for antibiotic use and allergic reactions.


RESULTS
Most of the 2,933 orthopedic patients, including 413 patients who were allergic to penicillin, received a cephalosporin (usually cefazolin) during their procedure. Only one of the penicillin-allergic patients may have had an allergic reaction to the cephalosporin, because diphenhydramine and hydrocortisone were given at the beginning of the case. However, no mention was made on the chart about itching or a rash or hives. One of the non-penicillin-allergic patients did develop a rash while the cephalosporin was infusing, requiring discontinuation of the antibiotic.


CONCLUSIONS
Given the low incidence of allergic reactions, it appears to be safe to administer cephalosporins to patients who claim to be allergic to penicillin. However, no conclusion can be made concerning patients who report severe or anaphylactic reactions to penicillin, because these patients probably were excluded from the study.
Goodman
E J
EJ
Department of Anesthesiology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH 44106, USA. evan.goodman@uhhs.com
Morgan
M J
MJ
Johnson
P A
PA
Nichols
B A
BA
Denk
N
N
Gold
B B
BB
D000707:Anaphylaxis / Q000139:chemically induced*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D002511:Cephalosporins / Q000008:administration & dosage* / Q000009:adverse effects; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010406:Penicillins / Q000009:adverse effects* / Q000276:immunology; D012189:Retrospective Studies
D002511:Cephalosporins; D010406:Penicillins