title: Tolerability of cefazolin after immune-mediated hypersensitivity reactions to nafcillin in the outpatient setting.
abstract: The objective of the present study was to assess the safety and tolerability of cefazolin therapy among patients with methicillin-sensitive Gram-positive bacterial infections who develop non-IgE-mediated hypersensitivity reactions (HSRs) to nafcillin. In this retrospective cohort analysis of the Outpatient Parenteral Antimicrobial Therapy program at the Massachusetts General Hospital from 2007 through 2013, we identified patients switched from nafcillin to cefazolin after an immune-mediated HSR. We reviewed patient demographics, details about the original HSR, and outcomes after the switch to cefazolin therapy. HSRs were classified by reaction type and likely mechanism. There were 467 patients treated with nafcillin, of which 60 (12.8%) were switched to cefazolin during their prescribed course. Of the 60 patients who transitioned to cefazolin, 17 (28.3%) were switched because of non-IgE-mediated HSRs. HSRs included maculopapular rash (n = 10), immune-mediated nephritis (n = 3), isolated eosinophilia (n = 2), immune-mediated hepatitis (n = 1), and a serum sickness-like reaction (n = 1). All but one patient (94.1%) who switched to cefazolin tolerated the drug with resolution of the HSR and completed their therapy with cefazolin. No patient experienced worsening of their rash or progressive organ dysfunction. With appropriate monitoring, therapy with cefazolin after non-IgE-mediated HSRs to nafcillin appears to be safe.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston Massachusetts, USA kblumenthal1@partners.org.
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Blumenthal
authors.affiliation: Harvard Medical School, Boston Massachusetts, USA Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Youngster
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston Massachusetts, USA Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Shenoy
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston Massachusetts, USA.
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.affiliation: Harvard Medical School, Boston Massachusetts, USA Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000276:immunology* / Q000627:therapeutic use*; D002437:Cefazolin / Q000737:chemistry / Q000627:therapeutic use*; D015331:Cohort Studies; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000517:prevention & control; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008712:Methicillin / Q000627:therapeutic use*; D008875:Middle Aged; D009254:Nafcillin / Q000737:chemistry / Q000276:immunology* / Q000627:therapeutic use; D010045:Outpatients; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D007155:Immunologic Factors; D009254:Nafcillin; D002437:Cefazolin; D008712:Methicillin