Difference between revisions of "EBQ:Cephalosporin Cross-reactivity"

(Created page with "Prior to 1980, penicillins and cephaloporins were often produced using the same fungus and the chance for contamination during the manufacturing process was high. The belief w...")
 
(Cross-Reaction Risk)
 
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Prior to 1980, penicillins and cephaloporins were often produced using the same fungus and the chance for contamination during the manufacturing process was high. The belief was that the beta-lactam ring similarities must be the cause. How wrong we were.
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==Background==
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Previously, [[penicillins]] (PCN) and [[cephalosporins]] were produced with the same fungi during synthesis.  This increased the rate of cross contamination especially prior to 1980.  Although the allergy was though to be due to the similarities in the beta-lactam ring it is more probably caused due to manufacturing contamination although there is cross reactivity risk based on side chain similarity.  1st and 2nd generation [[penicillins]] share the same R-1 side chain.<ref>UIC Pharmacology on Penicillin Cross Reactivity https://www.uic.edu/pharmacy/services/di/crossens.htm</ref>  However, a current review of the literature demonstrates that the 10% or greater allergy may be exaggerated.<ref name="campagna">Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: A literature review. J Emerg Med. 2012;42(5):612-20</ref>
  
More recent studies have determined that the actual risk of cross-reactivity relates more to a side chain similarity and probably not the beta-lactam ring at all. Therefore it makes sense that if a penicillin and a cephalosporin share that particular (R-1) side-chain similarity, the risk of cross-reactivity is increased. Such is the case with amoxicillin or ampicillin with:
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==Cross-Reaction Risk==
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* Overall cross-reactivity rate between [[cephalosporins]] and [[penicillins]] in patients reporting a penicillin allergy = 1%.  <ref name="campagna"></ref>
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* Overall cross-reactivity rate in patients with a confirmed penicillin allergy = 2.5%. <ref name="campagna"></ref>
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* Cross-reactivity between [[penicillins]] and 1st and 2nd generation [[cephalosporins]] is possible.<ref name="campagna"></ref>
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* Cross-reactivity between [[penicillins]] and ALL 3rd and 4th generation [[cephalosporins]] is negligible.<ref name="campagna"></ref>
  
* 1st generation cephalosporins: cefadroxil, cefatrizine, cephalexin, cephradine
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==Antibiotic Categories==
* 2nd generation cephalosporins: cefaclor, cefprozil
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{{Beta-lactams}}
  
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==External Links==
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*[https://umem.org/educational_pearls/2540/ UMEM - Penicillin Cephalosporin Cross-Reactivity Made Easy]
  
== Campagna Review Article==<ref>Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: A literature review. J Emerg Med. 2012;42(5):612-20</ref>
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==See Also==
* Overall cross-reactivity rate between cephalosporins and penicillins in patients reporting a penicillin allergy = 1%. 
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*[[Cephalosporins]]
* Overall cross-reactivity rate in patients with a confirmed penicillin allergy = 2.5%.
 
* Cross-reactivity between penicillins and MOST 1st and 2nd generation cephalosporins is negligible.
 
* Cross-reactivity between penicillins and ALL 3rd and 4th generation cephalosporins is negligible.
 
* If a patient has an allergy to amoxicillin or ampicillin, avoid cefadroxil, cefaclor, cefatrizine, cefprozil, cephalexin, and cephradine.
 
  
==Sources==
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==References==
 
<references/>
 
<references/>
http://www.ncbi.nlm.nih.gov/pubmed?term=21742459
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[[Category:EBQ]]
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[[Category:Pharmacology]]

Latest revision as of 16:40, 26 March 2019

Background

Previously, penicillins (PCN) and cephalosporins were produced with the same fungi during synthesis. This increased the rate of cross contamination especially prior to 1980. Although the allergy was though to be due to the similarities in the beta-lactam ring it is more probably caused due to manufacturing contamination although there is cross reactivity risk based on side chain similarity. 1st and 2nd generation penicillins share the same R-1 side chain.[1] However, a current review of the literature demonstrates that the 10% or greater allergy may be exaggerated.[2]

Cross-Reaction Risk

Antibiotic Categories

External Links

See Also

References

  1. UIC Pharmacology on Penicillin Cross Reactivity https://www.uic.edu/pharmacy/services/di/crossens.htm
  2. 2.0 2.1 2.2 2.3 2.4 Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: A literature review. J Emerg Med. 2012;42(5):612-20