29 Sep Adverse Reactions to Cephalosporin Antibiotics Reviewed

MedicalResearch.com Interview with:
Eric Macy, MS, MS
Allergy & Immunology
Kaiser Permanente Medical Group-Allergy

Medical Research: What are the main findings of the study?

Dr. Macy:

• Cephalosporins are currently widely and relatively safely used in individuals with a history of a penicillin “allergy” in their medical record.
• Cephalosporin associated anaphylaxis is very rare, even in individuals with a history of penicillin “allergy”.
• Cephalosporin associated serious cutaneous adverse reactions are extremely rare.
• Cephalosporin associated Clostridium difficile and serious nephropathy are relatively common.
  
  Medical Research: What was most surprising about the results?Dr. Macy: There would be about 1 more new cephalosporin “allergy” noted for every 135 individuals given a cephalosporin who have a penicillin “allergy” compared to individuals with no drug “allergies”.There would be about 1 more new cephalosporin “allergy” noted for every 159 individuals given a cephalosporin who have a penicillin “allergy” compared to individuals with any non-beta-lactam “allergy”.There would be about 1 more new cephalosporin “allergy” noted for every 233 individuals given a cephalosporin who have a penicillin “allergy” compared to individuals with another unrelated cephalosporin “allergy”.Medical Research: What should clinicians and patients take away from your report?Dr. Macy:
• The use of cephalosporins in individuals with a history of penicillin “allergy” is not associated with a clinically significant increased risk of adverse reactions being reported in the medical record.
• Adverse reactions occur with all antibiotic use.
• Inappropriate antibiotic use and antibiotic overuse is associated with significant morbidity.

  Medical Research: What recommendations do you have for future research as a result of this study?Dr. Macy: Cephalosporins should be used when clinically indicated in individuals with a history of penicillin allergy with additional testing warranted.Warnings should be placed on 3rd and higher generation cephalosporins highlighting the approximately 3% chance of having a Clostridium difficile infection diagnosed within 90 days of use.

  The unexpected relatively high rates of serious nephropathy associated with cephalosporin use should be investigated further.

  Citation:
  Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis

Publication date: Available online 26 September 2014
Journal of Allergy and Clinical Immunology
Eric Macy , Richard Contreras
DOI: http://dx.doi.org/10.1016/j.jaci.2014.07.062

Last Updated on September 29, 2014 by Marie Benz MD FAAD