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Transcript
1.2.5.
The prescriber and pharmacist should determine the next course of
action:
1.2.5.1.
Use an antibiotic from another class.
1.2.5.2.
Initiate a graded challenge (see section E) if the risk of
reaction is felt to be low.
1.2.5.3.
Penicillin skin testing.
1.2.5.3.1. Patients with a history of severe, non-IgE mediated
reactions should not be skin tested.
D. Side Chains
1.0
If the order is for a beta-lactam antibiotic that has the same side chain as the antibiotic
the patient is allergic to, the prescriber should be contacted for another antibiotic choice
4,14-16
Cefazolin does not share a common side
due to increased risk of cross-reactivity.
14
chain with any other beta-lactams. The following table lists beta-lactams with common
side chains:
Agent
Amoxicillin
Ampicillin
Aztreonam
Cefaclor
Cefadroxil
Cefamandole
Cefdinir
Cefepime
Cefixime
Cefotaxime
Cefotetan
Cefoxitin
Cefpodoxime
Cefprozil
Ceftazidime
Ceftibuten
Ceftizoxime
Ceftriaxone
Cefuroxime
Cephalexin
Cephalothin
Cephradine
Penicillin G
Agents with Common Side Chains
Ampicillin
Cefaclor
Cefadroxil
Amoxicillin
Cefaclor
Cefadroxil
Ceftazidime
Amoxicillin
Ampicillin
Cefadroxil
Amoxicillin
Ampicillin
Cefaclor
Cefotetan
Cefixime
Cefotaxime
Cefpodoxime
Ceftizoxime
Cefdinir
Cefepime
Cefpodoxime
Ceftizoxime
Cefamandole
Cefuroxime
Cephalothin
Penicillin G
Cefepime
Cefotaxime
Ceftizoxime
Amoxicillin
Ampicillin
Cefaclor
Aztreonam
Ceftizoxime
Cefepime
Cefotaxime
Cefpodoxime
Cefepime
Cefotaxime
Cefpodoxime
Cefoxitin
Amoxicillin
Ampicillin
Cefaclor
Cefotaxime
Cefoxitin
Penicillin G
Amoxicillin
Ampicillin
Cefaclor
Cefoxitin
Cephalothin
Cefprozil
Cefprozil
Cephalexin
Cephalexin
Cephradine
Cephradine
Cefprozil
Cefprozil
Cephalexin
Cephalexin
Cephradine
Cephradine
Ceftriaxone
Ceftriaxone
Cephalothin
Ceftriaxone
Cefadroxil
Cephalexin
Ceftibuten
Ceftizoxime
Ceftriaxone
Cefadroxil
Cefprozil
Cephradine
Cefadroxil
Cefprozil
Cephalexin
E. Graded Challenge
1.0
Cephradine
A graded challenge is cautiously administering a medication to a patient who is unlikely to
be allergic to it. It does not entail modification of the immune response. Since lower
doses are initially used, if an allergic reaction happens, hopefully it will be minor and
easily treated. Patient’s should have beta-blockers discontinued to prevent treatment
resistant anaphylaxis if it occurs.2,7,11
Procedure: give 1%, then 10%, then 100% of therapeutic dose at 30 minute intervals if no
reaction develops at each dosage increment
1.1.1 If a reaction develops, the patient should be desensitized