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Invited commentary: Promoting cephalosporin use among patients with penicillin allergy

  • Kaitlin M. Alexander
    Correspondence
    Reprint requests: Kaitlin M. Alexander.
    Affiliations
    Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL
    Clinical Pharmacy Specialist, Surgery/Trauma ICU, UF Health Shands Hospital, Gainesville, FL
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      Bhathal et al (2022) present data to support the use of cephalosporin surgical prophylaxis in the presence of a documented penicillin allergy.
      • Bhathal S.
      • Joseph E.
      • Nailor M.D.
      • et al.
      Adherence and outcomes of a surgical prophylaxis guideline promoting cephalosporin use among patients with penicillin allergy.
      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.
      • Bratzler D.W.
      • Dellinger E.P.
      • Olsen K.M.
      • et al.
      Clinical practice guidelines for antimicrobial prophylaxis in surgery.
      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.
      • Shenoy E.S.
      • Macy E.
      • Rowe T.
      • et al.
      Evaluation and Management of Penicillin Allergy: a Review.
      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.
      • Bertram C.M.
      • Postelnick M.
      • Mancini C.M.
      • et al.
      Association of β-lactam allergy documentation and prophylactic antibiotic use in surgery: a national cross-sectional study of hospitalized.
      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.
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      References

        • Bhathal S.
        • Joseph E.
        • Nailor M.D.
        • et al.
        Adherence and outcomes of a surgical prophylaxis guideline promoting cephalosporin use among patients with penicillin allergy.
        Surgery. 2022; 172: 1598-1603
        • Bratzler D.W.
        • Dellinger E.P.
        • Olsen K.M.
        • et al.
        Clinical practice guidelines for antimicrobial prophylaxis in surgery.
        Am J Health Syst Pharm. 2013; 70: 195-283
        • Shenoy E.S.
        • Macy E.
        • Rowe T.
        • et al.
        Evaluation and Management of Penicillin Allergy: a Review.
        JAMA. 2019; 321: 188-199
        • Bertram C.M.
        • Postelnick M.
        • Mancini C.M.
        • et al.
        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
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        • Solensky R.
        • Earl H.S.
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        Safety of cephalosporin administration to patients with histories of penicillin allergy.
        J Allergy Clin Immunol. 2004; 113: 1220-1222
        • Macy E.
        • McCormick T.A.
        • Adams J.L.
        • et al.
        Association between removal of a warning against cephalosporin use in patients with penicillin allergy and antibiotic prescribing.
        JAMA Netw Open. 2021; 4e218367