Β-lactam allergy: Difference between revisions
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Β-lactam allergy
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==Cross-Reactivity== |
==Cross-Reactivity== |
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*Cross-reactivity between [[penicillins]] and [[cephalosporins]] is mediated by homology of the R1 side chains, referring to the C6 side chain in [[penicillins]] or the C7 side chain in [[cephalosporins]] |
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*Cross-reactivity within [[cephalosporins]] is mediated both by homology of the R1 side chains and also R2 side chains, referring to the C3 side chain |
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! colspan="11" |Penicillins |
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|[[Penicillin]] |
|[[Penicillin]] |
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! colspan="11" |First-Generation Cephalosporins |
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|[[Cefazolin]] |
|[[Cefazolin]] |
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! colspan="11" |Second-Generation Cephalosporins |
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|[[Cefotetan]] |
|[[Cefotetan]] |
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! colspan="11" |Third-Generation Cephalosporins |
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|[[Cefotaxime]] |
|[[Cefotaxime]] |
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! colspan="11" |Fourth-Generation Cephalosporins and Higher |
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|[[Cefipime]] |
|[[Cefipime]] |
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===R1 Side Chains (C6 and C7)=== |
===R1 Side Chains (C6 and C7)=== |
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*'''Group 1:''' [[penicillin]], [[cephalothin]], [[cefoxitin]] |
*'''Group 1:''' [[penicillin]], [[cephalothin]], [[cefoxitin]]; similar to [[ticarcillin]] |
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*'''Group 2:''' [[amoxicillin]], [[ampicillin]], [[cefaclor]], [[cephalexin]], [[cefadroxil]] |
*'''Group 2:''' [[amoxicillin]], [[ampicillin]], [[cefaclor]], [[cephalexin]], [[cefadroxil]]; similar to [[penicillin]] [[piperacillin]] |
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*'''Group 3:''' [[cefipime]], [[cefotaxime]], [[ceftriaxone]] |
*'''Group 3:''' [[cefipime]], [[cefotaxime]], [[ceftriaxone]]; similar to [[ceftazidime]] and [[aztreonam]] |
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*[[Ceftazidime]] and [[aztreonam]]; similar to group 3 |
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===R2 Side Chains (C3)=== |
===R2 Side Chains (C3)=== |
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Revision as of 14:22, 16 September 2020
Cross-Reactivity
- Cross-reactivity between penicillins and cephalosporins is mediated by homology of the R1 side chains, referring to the C6 side chain in penicillins or the C7 side chain in cephalosporins
- Cross-reactivity within cephalosporins is mediated both by homology of the R1 side chains and also R2 side chains, referring to the C3 side chain
| Antibiotic | R1 | R2 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| G1 | G2 | G3 | G1 | G2 | G3 | G4 | G5 | G6 | G7 | |
| Penicillins | ||||||||||
| Penicillin | X | |||||||||
| Ampicillin | X | |||||||||
| Amoxicillin | X | |||||||||
| First-Generation Cephalosporins | ||||||||||
| Cefazolin | ||||||||||
| Cephalexin | X | X | ||||||||
| Cefadroxil | X | X | ||||||||
| Cephalothin | X | X | ||||||||
| Second-Generation Cephalosporins | ||||||||||
| Cefotetan | X | |||||||||
| Cefoxitin | X | X | ||||||||
| Cefuroxime | X | |||||||||
| Cefaclor | X | |||||||||
| Third-Generation Cephalosporins | ||||||||||
| Cefotaxime | X | X | ||||||||
| Ceftriaxone | X | |||||||||
| Ceftazidime | X | |||||||||
| Cefixime | X | |||||||||
| Cefdinir | ||||||||||
| Fourth-Generation Cephalosporins and Higher | ||||||||||
| Cefipime | X | |||||||||
| Ceftaroline | ||||||||||
R1 Side Chains (C6 and C7)
- Group 1: penicillin, cephalothin, cefoxitin; similar to ticarcillin
- Group 2: amoxicillin, ampicillin, cefaclor, cephalexin, cefadroxil; similar to penicillin piperacillin
- Group 3: cefipime, cefotaxime, ceftriaxone; similar to ceftazidime and aztreonam
- Ceftazidime and aztreonam; similar to group 3
R2 Side Chains (C3)
- Group 1: cefadroxil, cephalexin
- Group 2: cefotetan
- Group 3: cefotaxime, cephalothin
- Group 4
- Group 5: cefuroxime, cefoxitin
- Group 6: cefixime
- Group 7: ceftazidime
Hypersensitivity Reactions
- Type I (IgE-mediated)
- Anaphylaxis
- Itchy rash
- Penicillins should be avoided
- Type II (IgG-mediated)
- Non-itchy rash
- Rash will improve if treatment continues, no need to avoid penicillins
- Type IV (cell-mediated)
- Toxic epidermal necrolysis
- Stevens-Johnson syndrome
- Penicillins should be avoided
Further Reading
- Zagursky RJ and Pichichero ME. Cross-reactivity in β-Lactam Allergy. J Allergy Clin Immunol Pract. 2018;6(1):72-81.e1. doi: 10.1016/j.jaip.2017.08.027
References
- ^ Brittany Kula, Gordana Djordjevic, Joan L. Robinson. A Systematic Review: Can One Prescribe Carbapenems to Patients With IgE-Mediated Allergy to Penicillins or Cephalosporins?. Clinical Infectious Diseases. 2014;59(8):1113-1122. doi:10.1093/cid/ciu587.
