Updated Penicillin–Cephalosporin Cross-Reactivity Alerts and Cephalosporin Use in Patients With Penicillin Allergy

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Among 26,903 patients with penicillin allergy labels, a revised risk-stratified alert was associated with increased cephalosporin use across inpatient, operating room, and outpatient settings.
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Mean weekly cephalosporin use increased 17.8% for inpatient administrations, 35.4% in operating rooms, and 16.7% for outpatient orders.
3

After implementation, weekly fluoroquinolone use decreased 12.5% and clindamycin use decreased 34.5%, while carbapenem and metronidazole use did not change significantly.
4

The revised alerts reduced weekly penicillin-cephalosporin cross-reactivity alerts by 86%, and prescribers canceled 67.2% of orders after receiving the new in-line alert.
5

Review of 28 epinephrine administrations within 1 hour of cephalosporin exposure found no anaphylaxis; long-term outcomes and delayed allergy effects were not evaluated.

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