title: Penicillin allergy and surgical prophylaxis: Cephalosporin cross-reactivity risk in a pediatric tertiary care center.
abstract: BACKGROUND
  First generation cephalosporins are commonly used as antibiotic prophylaxis prior to surgery. Patients labeled as penicillin-allergic are often precluded from receiving cephalosporins because of an allergic cross-reactivity. The aims of this study were to evaluate the clinical practice for surgical prophylaxis at Nationwide Children's Hospital and to determine the incidence of adverse effects and allergic reactions when using cephalosporins in patients labeled as penicillin-allergic.
  
  
  METHODS
  A retrospective chart review was performed to identify patients who were allergic to penicillin, penicillin antibiotic family, who required surgical treatment for an existing medical condition, and received an antibiotic to prevent surgical site infection.
  
  
  RESULTS
  Five hundred thirteen penicillin-allergic patients were identified, encompassing 624 surgical cases. Cephalosporins were administered in 153 cases (24.5%) with cefazolin used 83% of the time. Only one documented case of nonanaphylactic reaction was reported. Clindamycin was the most common cephalosporin substitute (n=387), and the reported adverse reaction rate was 1.5%. No cases of anaphylaxis were documented.
  
  
  CONCLUSIONS
  Our data suggest that the administration of cephalosporins for surgical prophylaxis following induction of anesthesia in a patient with a known or reported penicillin-allergy appears appropriate and results in a lower adverse event rate that when clindamycin is administered.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA. Electronic address: ralph.beltran@nationwidechildrens.org.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Beltran
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA. Electronic address: hiromi.kako@nationwidechildrens.org.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kako
authors.affiliation: Enterprise Data Warehouse, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: thomas.chovanec@nationwidechildrens.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chovanec
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA. Electronic address: archana.ramesh@nationwidechildrens.org.
authors.forename: Archana
authors.initials: A
authors.lastname: Ramesh
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Columbus, OH, USA; Department of Anesthesia, University of Toronto, Toronto, Canada. Electronic address: bruno@brainstorm-anesthesia.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bissonnette
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA. Electronic address: joseph.tobias@nationwidechildrens.org.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000453:epidemiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010406:Penicillins / Q000009:adverse effects*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins
keywords: Cephalosporin; Cross-reactivity; Pediatrics; Penicillin allergy; Surgical prophylaxis