Bhathal et al (2022) present data to support the use of cephalosporin surgical prophylaxis
in the presence of a documented penicillin allergy.
1
Cephalosporins, such as cefazolin, are the preferred agent for prophylaxis for the
majority of procedures. Non-β-lactam alternatives are recommended for patients with
life-threatening allergies; however, this recommendation is based on low-quality evidence
and assumptions from antibiotic spectrum of activity.
2
Importantly, the use of non-β-lactam surgical prophylaxis has demonstrated an increase
in the risk of surgical site infection; therefore, β-lactam antibiotics should be
utilized when possible.
3
I commend the authors of the current article for investigating this important topic
to improve the quality of surgical prophylaxis delivered to patients with penicillin
allergies, who are more likely to receive non-β-lactam prophylaxis, such as clindamycin,
gentamicin, fluoroquinolones, and vancomycin.
4
Surgeons, and particularly resident learners who often order surgical prophylaxis,
may not consider the reduced efficacy of non-β-lactam alternatives when faced with
the decision to prescribe a second-line agent for a patient with a documented penicillin
allergy.To read this article in full you will need to make a payment
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References
- Adherence and outcomes of a surgical prophylaxis guideline promoting cephalosporin use among patients with penicillin allergy.Surgery. 2022; 172: 1598-1603
- Clinical practice guidelines for antimicrobial prophylaxis in surgery.Am J Health Syst Pharm. 2013; 70: 195-283
- Evaluation and Management of Penicillin Allergy: a Review.JAMA. 2019; 321: 188-199
- Association of β-lactam allergy documentation and prophylactic antibiotic use in surgery: a national cross-sectional study of hospitalized.Clin Infect Dis. 2021; 72: e872-e875
- Safety of cephalosporin administration to patients with histories of penicillin allergy.J Allergy Clin Immunol. 2004; 113: 1220-1222
- Association between removal of a warning against cephalosporin use in patients with penicillin allergy and antibiotic prescribing.JAMA Netw Open. 2021; 4e218367
Article info
Publication history
Published online: June 17, 2022
Accepted:
May 14,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
