Evaluation of penicillin allergy before deciding not to use penicillin or other β-lactam antibiotics is an important tool for antimicrobial stewardship. Many patients report they are allergic to penicillin but few have clinically significant reactions. Clinicians performing penicillin allergy evaluation need to identify what methods are supported by their available resources. Moderate-risk patients can be evaluated with penicillin skin testing, which carries a negative predictive value that exceeds 95% and approaches 100% when combined with amoxicillin challenge. Direct amoxicillin challenge is appropriate for patients with low-risk allergy histories. Some patients have a medical history that suggests they are at a low risk for developing an allergic reaction to penicillin. Based on these data and our previous clinical experience, there appears to be little/no potential cross reactivity between meropenem and. Cross-reactivity between penicillin and cephalosporin drugs occurs in about 2 of cases, less than the 8 reported previously. Broad-spectrum antimicrobial agents also increase the risk of developing Clostridium difficile (also known as Clostridioides difficile) infection. During a 12-month period, 110 patients with non-anaphylactic (59) and anaphylactic (51) penicillin allergic reactions tolerated prolonged meropenem therapy (1-4 weeks) safely without any allergic reactions. The goals of antimicrobial stewardship are undermined when reported allergy to penicillin leads to the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance, including increased risk of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. A high-risk history includes patients who have had anaphylaxis, positive penicillin skin testing, recurrent penicillin reactions, or hypersensitivities to multiple β-lactam antibiotics. A moderate-risk history includes urticaria or other pruritic rashes and reactions with features of IgE-mediated reactions. Although many patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte-mediated penicillin hypersensitivity is uncommon (10 years) unknown reactions without features suggestive of an IgE-mediated reaction. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events.Īpproximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. Β-Lactam antibiotics are among the safest and most effective antibiotics.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |