title: Prophylactic Antibiotic Management of Surgical Patients Noted as "Allergic" to Penicillin at Two Academic Hospitals.
abstract: We studied prophylactic antibiotics administered at 2 academic medical centers during a 6-year period where a cephalosporin was indicated but an "allergy" to penicillin was noted. Another drug (typically vancomycin or clindamycin) was substituted approximately 80% of the time; this occurred frequently even when symptoms unrelated to acute hypersensitivity were listed. In >50% of cases, the reaction was either omitted or vague (e.g., simply "rash"). Given the estimated 1% cross-reactivity between penicillins and cephalosporins with similar R1 side chains, many of these patients could have received either the prescribed cephalosporin or another cephalosporin with a different R1 side chain.
authors.affiliation: From the *Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; †Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and ‡Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Epstein
authors.forename: Paul St
authors.initials: PS
authors.lastname: Jacques
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Wanderer
authors.forename: Mark R
authors.initials: MR
authors.lastname: Bombulie
authors.forename: Niraj
authors.initials: N
authors.lastname: Agarwalla
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002511:Cephalosporins / Q000008:administration & dosage; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000517:prevention & control*; D057286:Electronic Health Records; D006801:Humans; D010406:Penicillins / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins