Preoperative Cefazolin use safe for patients with penicillin allergy labels
Seattle, WA: The use of cefazolin before surgery in patients with a penicillin allergy label (PAL) did not lead to allergic symptoms related to the antibiotic in any of the patients, new research has revealed. The study was published in Annals of Allergy, Asthma & Immunology on March 23, 2022.
Cefazolin is a first-line antibiotic for the perioperative treatment of surgical site infections (SSIs). Patients with PAL use cefazolin less frequently and are more likely to receive alternative antibiotics that increase their risk of SSI. This is likely from overestimating the risk of cross-reactivity between penicillin and cephalosporins. Cross-reactivity is said to be due to a common R1 side chain that is absent in cefazolin.
Jocelyn J. Cooper, Division of Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, and colleagues hypothesized that cefazolin use is safe in most PAL patients. They aimed to learn about cefazolin use in patients with PALs, a population commonly encountered by clinicians in the perioperative setting who may not have confirmed IgE-mediated penicillin allergies.
For this purpose, the team queried the electronic medical records of 1,741 patients with PALs who had surgical procedures between Jan. 1 and Dec. 31, 2020, at the University of Washington Medical Center.
The study led to the following findings:
- Of these 1,741 patients, 549 (white, 77.2%; women, 61.9%) used cefazolin before their surgery. Their PALs included all penicillin (52.3%), amoxicillin (28.6%) or amoxicillin-clavulanate (13.8%), with some PALs including multiple types of penicillin.
- 427 of these patients (77.8%) had documented index reactions, including rash (40%), gastrointestinal upset (25.3%), hives (20.6%), respiratory distress (1.9%), anaphylaxis (1.2%) and angioedema (0.7%).
- 544 (99.1%) of the patients with PAL who received cefazolin had no documented postoperative allergic-type reaction, and the researchers did not consider the reactions in the five remaining patients to be related to the cefazolin. Two of these patients had index reactions of rash and developed postoperative pruritis 4 hours after receiving cefazolin, which the researchers attributed to opioid medication. The third patient had index reactions of rash and hives and had intraoperative anaphylaxis 3 hours after the cefazolin dose.
- The fourth patient had an index reaction of rash and developed postoperative pruritus, although there was no immediate reaction when cefazolin was administered 2.5 hours earlier.
- The final patient had an index reaction of rash with intraoperative anaphylaxis 15 minutes after receiving cefazolin. Skin testing for cefazolin and penicillin during outpatient evaluation was negative, but it was positive for rocuronium, which the patient received immediately before the reaction.
Based on the findings the researchers conclude, "patients with a PAL could safely use cefazolin prophylactically before surgery."
Reference:
The study titled, "Safety of Cefazolin for Perioperative Prophylaxis in Patients with Penicillin Allergy Labels," was published in Annals of Allergy, Asthma & Immunology.
DOI: https://doi.org/10.1016/j.anai.2022.03.015
KEYWORDS: Annals of Allergy Asthma & Immunology, penicillin allergy label, cefazolin, penicillin, antibiotics, surgery, surgical site infection, Jocelyn J Cooper, allergy
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