A Review of Evidence Supporting the American Academy of Pediatrics Recommendation for Prescribing Cephalosporin Antibiotics for Penicillin-Allergic Patients
University of Rochester Medical Center, Elmwood Pediatric Group, 601 Elmwood Ave, Box 672, Rochester, NY 14642, USA. PEDIATRICS
(Impact Factor: 5.47).
05/2005; 115(4):1048-57. DOI: 10.1542/peds.2004-1276
The American Academy of Pediatrics, evidence-based guidelines endorse the use of cephalosporin antibiotics for patients with reported allergies to penicillin, for the treatment of acute bacterial sinusitis and acute otitis media. Many physicians, however, remain reluctant to prescribe such agents. Although such concern is understandable, lack of consistent data regarding exactly what constitutes an initial penicillin-allergic reaction and subsequent cross-sensitivity to cephalosporins may be preventing many patients from receiving optimal antibiotic therapy. This article reviews evidence in support of the American Academy of Pediatrics recommendation. Included is an examination of the types and incidence of reactions to penicillins and cephalosporins; the frequency of cross-reactivity between these 2 groups of agents; experimental and clinical studies that suggest that side chain-specific antibodies predominate in the immune response to cephalosporins, thereby explaining the lack of cross-sensitivity between most cephalosporins and penicillins; the role of skin testing; and the risks of anaphylaxis. Specific recommendations for the treatment of patients on the basis of their responses to previously prescribed agents are summarized.
Available from: Jettanong Klaewsongkram
- "In clinical practice, the confirmation of penicillin allergic status is not always feasible, which results in unnecessary avoidance of beta-lactam antibiotics in patients who are overdiagnosed . It is well recognized nowadays that the crossreactivity rate among beta-lactams is lower than previously expected . However, the consensus recommendation of antibiotic selection in these " suspected " penicillin allergic patients has yet to be established   . "
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ABSTRACT: The purpose of this study was to compare the management of patients with a history of penicillin allergy between allergists and non-allergists in Thailand. A questionnaire was distributed to Thai physicians by online survey. The answers from 205 physicians were analyzed. The discrepancy of penicillin allergy management between allergists and non-allergists was clearly demonstrated in patients with a history of an immediate reaction in the presence of penicillin skin test (
) and in patients with a history of Stevens-Johnson syndrome (
) from penicillin. Allergists are more willing to confirm penicillin allergic status, more likely to carefully administer penicillin even after negative skin test, but less concerned for the potential cross-reactivity with 3rd and 4th generation cephalosporins, compared to non-allergists. The lack of penicillin skin test reagents, the reliability of penicillin allergy history, and medicolegal problem were the main reasons for prescribing alternate antibiotics without confirmation of penicillin allergic status. In summary, the different management of penicillin allergy between allergists and non-allergists was significantly demonstrated in patients with a history of severe non-immediate reaction and in patients with a history of an immediate reaction when a penicillin skin test is available.
Available from: PubMed Central
- "Most medical knowledge about treatment response and diagnostic categories and physiologies rests on observations made on groups of patients. Take, for example, the effect of glycemic control on retinopathy of type 1 diabetes patients as a function of their glycohemoglobin ; the time to recurrence of HER2-positive breast cancer patients ; or the degree of shared allergenicity of various insulin-derived antibiotics : all these pieces of knowledge are based on characterization of subgroups of patients defined as having some shared characteristics that define their group within a formal study or by anecdote. Here, again, the characteristics of the group can range from genetic to behavioral characterizations, and for each subgroup of patients there is a set of medical characterizations, whether they be therapeutic susceptibility or prognostic course, that are known with varying degrees of certainty. "
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ABSTRACT: Personalized medicine is typically described as the use of molecular or genetic characteristics to customize therapy. This perspective at best provides an incomplete model of the patient and at worst can lead to grossly inappropriate practices. Personalization of medicine requires two characterizations: a well-grounded understanding of who the patient is and an equally robust understanding of the subpopulation that most resembles that patient in the context of the decisions at hand. These characterizations are readily represented probabilistically and can be used to drive decision-making in a rational manner that maximizes the positive outcomes for the patient.
Available from: scoutcpr.org
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