Β-lactam allergy: Difference between revisions

Revision as of 14:07, 16 August 2020

Cross-reactivity

Antibiotic	C7			C3
Antibiotic	G1	G2	G3	G1	G2	G3	G4	G5	G6	G7
Penicillin	X
Ampicillin		X
Amoxicillin		X
Cefazolin
Cephalexin		X		X
Cefadroxil		X		X
Cephalothin	X					X
Cefotetan					X
Cefoxitin	X							X
Cefuroxime								X
Cefaclor		X
Cefotaxime			X			X
Ceftriaxone			X
Ceftazidime										X
Cefixime									X
Cefdinir
Cefipime			X
Ceftaroline

C-7 Side Chains

Group 1: penicillin, cephalothin, cefoxitin
Group 2: amoxicillin, ampicillin, cefaclor, cephalexin, cefadroxil
Group 3: cefipime, cefotaxime, ceftriaxone

C-3 Side Chains

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

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.
^ Anna R. Wolfson, Emily M. Huebner, Kimberly G. Blumenthal. Acute care beta-lactam allergy pathways: approaches and outcomes. Annals of Allergy, Asthma & Immunology. 2019;123(1):16-34. doi:10.1016/j.anai.2019.04.009.

Β-lactam allergy: Difference between revisions

Revision as of 14:07, 16 August 2020

Contents

Cross-reactivity

C-7 Side Chains

C-3 Side Chains

Hypersensitivity Reactions

Further Reading

References

@@ Line 1: / Line 1: @@
-== Cross-reactivity ==
+==Cross-reactivity==
 {| class="wikitable"
+! rowspan="2" |Antibiotic
-!
-!align="center"| C-7 G1
+! colspan="3" align="center" |C7
-!align="center"| C-7 G2
+! colspan="7" align="center" |C3
-!align="center"| C-7 G3
-!align="center"| C-3 G1
-!align="center"| C-3 G2
-!align="center"| C-3 G3
-!align="center"| C-3 G4
-!align="center"| C-3 G5
-!align="center"| C-3 G6
-!align="center"| C-3 G7
 |-
+!G1
-| [[Penicillin]]
+!G2
-|align="center"| X
+!G3
-|align="center"|
+!G1
-|align="center"|
+!G2
-|align="center"|
+!G3
-|align="center"|
+!G4
-|align="center"|
+!G5
-|align="center"|
+!G6
-|align="center"|
+!G7
-|align="center"|
-|align="center"|
 |-
-| [[Ampicillin]]
+|[[Penicillin]]
-|align="center"|
+| align="center" |X
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Amoxicillin]]
+|[[Ampicillin]]
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefazolin]]
+|[[Amoxicillin]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cephalexin]]
+|[[Cefazolin]]
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefadroxil]]
+|[[Cephalexin]]
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cephalothin]]
+|[[Cefadroxil]]
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefotetan]]
+|[[Cephalothin]]
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefoxitin]]
+|[[Cefotetan]]
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefuroxime]]
+|[[Cefoxitin]]
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefaclor]]
+|[[Cefuroxime]]
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Cefotaxime]]
+|[[Cefaclor]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Ceftriaxone]]
+|[[Cefotaxime]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Ceftazidime]]
+|[[Ceftriaxone]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
 |-
-| [[Cefixime]]
+|[[Ceftazidime]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |X
 |-
-| [[Cefdinir]]
+|[[Cefixime]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
 |-
-| [[Cefipime]]
+|[[Cefdinir]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"| X
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
 |-
-| [[Ceftaroline]]
+|[[Cefipime]]
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |X
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
-|align="center"|
+| align="center" |
+|-
+|[[Ceftaroline]]
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
+| align="center" |
 |}
-=== C-7 Side Chains ===
+===C-7 Side Chains===
-* '''Group 1:''' [[penicillin]], [[cephalothin]], [[cefoxitin]]
-* '''Group 2:''' [[amoxicillin]], [[ampicillin]], [[cefaclor]], [[cephalexin]], [[cefadroxil]]
-* '''Group 3:''' [[cefipime]], [[cefotaxime]], [[ceftriaxone]]
-=== C-3 Side Chains ===
-* '''Group 1:''' [[cefadroxil]], [[cephalexin]]
+*'''Group 1:''' [[penicillin]], [[cephalothin]], [[cefoxitin]]
-* '''Group 2:''' [[cefotetan]]
+*'''Group 2:''' [[amoxicillin]], [[ampicillin]], [[cefaclor]], [[cephalexin]], [[cefadroxil]]
-* '''Group 3:''' [[cefotaxime]], [[cephalothin]]
+*'''Group 3:''' [[cefipime]], [[cefotaxime]], [[ceftriaxone]]
-* '''Group 4'''
-* '''Group 5:''' [[cefuroxime]], [[cefoxitin]]
-* '''Group 6:''' [[cefixime]]
-* '''Group 7:''' [[ceftazidime]]
+===C-3 Side Chains===
-[[File:zagursky2017.jpg|Comparison of R1 and R2 structural similarities between b-lactam drugs]]
+*'''Group 1:''' [[cefadroxil]], [[cephalexin]]
-Drugs that have identical R1 or R2 structures are listed as R1 (red cell) or R2 (gold cell). If only the ring or branch chain moiety of the R1 structure is identical, it is listed as R10 or R100, respectively. Drugs that have similar R1 or R2 structures are listed as r1 or r2. If only the ring or branch chain moiety of the R1 structure is similar, it is listed as r10 or r100, respectively. Blank cells imply no R1 or R2 structural similarities.
+*'''Group 2:''' [[cefotetan]]
+*'''Group 3:''' [[cefotaxime]], [[cephalothin]]
+*'''Group 4'''
+*'''Group 5:''' [[cefuroxime]], [[cefoxitin]]
+*'''Group 6:''' [[cefixime]]
+*'''Group 7:''' [[ceftazidime]]
-== Hypersensitivity Reactions ==
+==Hypersensitivity Reactions==
-* Type I (IgE-mediated)
+*'''Type I (IgE-mediated)'''
-** Anaphylaxis
+**Anaphylaxis
-** Itchy rash
+**Itchy rash
-** Penicillins '''should be avoided'''
+**Penicillins '''should be avoided'''
-* Type II (IgG-mediated)
+*'''Type II (IgG-mediated)'''
-** Non-itchy rash
+**Non-itchy rash
-** Rash will improve if treatment continues, '''no need to avoid''' penicillins
+**Rash will improve if treatment continues, '''no need to avoid''' penicillins
-* Type IV (cell-mediated)
+*'''Type IV (cell-mediated)'''
-** Toxic epidermal necrolysis
+**Toxic epidermal necrolysis
-** Stevens-Johnson syndrome
+**Stevens-Johnson syndrome
-** Penicillins '''should be avoided'''
+**Penicillins '''should be avoided'''
-== Further Reading ==
+==Further Reading==
-* Zagursky RJ and Pichichero ME.[http://dx.doi.org/10.1016/j.jaip.2017.08.027 Cross-reactivity in β-Lactam Allergy]. ''J Allergy Clin Immunol Pract''. 2018;6(1):72-81.e1.
+*Zagursky RJ and Pichichero ME. Cross-reactivity in β-Lactam Allergy. ''J Allergy Clin Immunol Pract''. 2018;6(1):72-81.e1. doi: [https://doi.org/10.1016/j.jaip.2017.08.027 10.1016/j.jaip.2017.08.027]
 [[Category:Antibiotics]]