Safety of Cefuroxime as an Alternative in Patients with a Proven Hypersensitivity to Penicillins: A DAHD Cohort Survey

Abstract

Objective: In patients sensitized to β-lactams, a safe β-lactam alternative is often needed. The objective was to assess the safety of cefuroxime in patients with a proven β-lactam allergy. Design: Using the Drug Allergy and Hypersensitivity Database cohort, patients with a proven β-lactam allergy and tested for cefuroxime between September 1996 and April 2007 were selected. The European Network of Drug Allergy recommendations were followed. Prevalence of sensitization to cefuroxime (as an alternative) was established in patients with a proven β-lactam allergy. Results: Amongst the 650 subjects tested, 143 (22.0%) presented at least one β-lactam sensitization other than cefuroxime [39–27.3% male, median age at test 44.0 (32.0–56.0) years]. One hundred and eighteen (82.5%) were sensitized to penicillins, 8 (5.6%) to cephalosporins and 17 (11.9%) to both penicillins and cephalosporins. Nine (6.3%) patients were sensitized to cefuroxime (6 diagnosed by provocation test): 5 (55.6%) in the penicillin-only allergic group and 4 (44.4%) in the penicillin and cephalosporin allergic group. Prevalence of cefuroxime hypersensitivity reaction in patients sensitized to β-lactams was 6.3% (95% CI 2.3–10.3%) and in those sensitized to penicillin 4.2% (95% CI 0.6–7.9). This rate decreased to 2.9% (95% CI 0–6.9) in patients with prior histories involving a penicillin only (without any history involving an unknown β-lactam). Conclusion: Cefuroxime appeared to be a safe alternative in β-lactam-allergic patients after testing. The risk of giving cefuroxime being not null, a thorough drug allergy work-up, including provocation test, is still needed.