Perioperative Management of the Penicillin-Allergic Patient

Abstract

AN ESTIMATED 32 MILLION AMERICANS have a documented penicillin allergy in their medical record, which equates to approximately 10% of the population in the United States. 1 Evaluation and diagnosis of penicillin allergy for healthcare professionals: is it really a penicillin allergy. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), 2017https://www.cdc.gov/antibiotic-use/community/for-hcp/Penicillin-Allergy.htmlDate accessed: August 1, 2019 Google Scholar Yet more than 97% are not at risk for an acute allergic reaction to penicillin. 2 Fox S. Park M.A. Penicillin skin testing in the evaluation and management of penicillin allergy. Ann Allergy Asthma Immunol. 2011; 106: 1-7 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Many agents recommended as first-line therapy for surgical infection prophylaxis are among the β-lactam pharmaceutical class, such as penicillin, aminopenicillins, cephalosporins, monobactams, and carbapenems (Table 1). 3 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 Crossref PubMed Scopus (1275) Google Scholar Studies indicate that 76% to 93% of patients who report a penicillin allergy receive second-line antibiotics for surgical infection prophylaxis. 4 Stone A.H. Kelmer G. MacDonald J.H. Clance M.R. King P.J. The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. J Am Acad Orthop Surg. 2019; ([Epub ahead of print])https://doi.org/10.5435/JAAOS-D-18-00709 Crossref Scopus (22) Google Scholar , 5 Blumenthal K.G. Ryan E.E. Li Y. Lee H. Kuhlen J.L. Shenoy E.S. The impact of a reported penicillin allergy on surgical site infection risk. Clin Infect Dis. 2018; 66: 329-336 Crossref PubMed Scopus (204) Google Scholar , 6 Beltran R.J. Kako H. Chovanec T. Ramesh A. Bissonnette B. Tobias J.D. Penicillin allergy and surgical prophylaxis: cephalosporin cross-reactivity risk in a pediatric tertiary care center. J Pediatr Surg. 2015; 50: 856-859 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Table 1β-Lactam Antimicrobials in the Surgical Prophylaxis Guidelines 3 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 Crossref PubMed Scopus (1275) Google Scholar Penicillin Derivatives Cephalosporins Monobactam Carbapenem Ampicillin Cefazolin Aztreonam Ertapenem Ampicillin-sulbactam Cefotetan Piperacillin-tazobactam Cefoxitin Cefotaxime Ceftriaxone Cefepime Open table in a new tab Rachel C. Wolfe, PharmD, MHA, BCCCP, Pharmacy Department, Barnes-Jewish Hospital, St. Louis, MO