Clinical Scorecard: Updated Penicillin–Cephalosporin Cross-Reactivity Alerts and Cephalosporin Use in Patients With Penicillin Allergy
At a Glance
Category
Detail
Condition
Penicillin allergy labels and penicillin–cephalosporin cross-reactivity
Key Mechanisms
Cross-reactivity is uncommon and is associated with particular penicillin–cephalosporin pairs sharing R side chains; the article also notes concern about severe T-cell-mediated penicillin reactions.
Target Population
Patients with penicillin allergy labels documented in the electronic health record who received care at Vanderbilt University Medical Center.
Care Setting
A multi-setting academic medical system, including inpatient, operating room, and outpatient care.
Key Highlights
A risk-stratified electronic alert replaced alerts triggered by any cephalosporin order for a patient with a penicillin allergy label.
After implementation, cephalosporin use increased by 17.8% for inpatient administrations, 35.4% in the operating room, and 16.7% for outpatient orders.
Weekly penicillin–cephalosporin cross-reactivity alerts decreased by 86%.
Fluoroquinolone and clindamycin use decreased among hospitalized patients with penicillin allergy labels; carbapenem and metronidazole use did not change significantly.
Review of 28 epinephrine administrations within one hour of cephalosporin exposure found none represented anaphylaxis.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
The authors report concern about unknown cross-reactivity in severe T-cell-mediated penicillin reactions and uncommon IgE-mediated cross-reactivity involving shared R side chains.
Long-term effects on surgical site infections, length of stay, readmissions, and other quality measures were not evaluated, according to the authors.
The authors note that the quality of allergy information documented in the electronic health record is poor.
Patient & Prescribing Data
The study included 26,903 patients with penicillin allergy labels documented in the electronic health record who received usual care at Vanderbilt University Medical Center; the study period is not specified here.
Clinical Best Practices
The study implemented risk-stratified cross-reactivity alerts rather than alerts triggered solely by any penicillin allergy label.
The article describes cross-reactivity as associated with selected penicillin–cephalosporin pairs sharing R side-chain structures.
The authors report concern about severe T-cell-mediated reactions and uncommon IgE-mediated reactions involving shared side chains.
The authors identify poor electronic health record allergy-information quality as a limitation.
by Cosby A. Stone, Scott D. Nelson, Laura Zahn, Allison B. McCoy, Megan Z. Wang, Ritu Banerjee, Milner Staub, Dara Mize, Elizabeth J. Phillips, Adam Wright
