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Perioperative Use of Cefazolin in Patients with Reported Penicillin Allergy
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Allison Ramsey, MD, Mary Staicu, PharmD, Leanna Liu

Rationale:

Cephalosporin antibiotics are the mainstay of surgical prophylaxis given their favorable safety and efficacy profile.  Despite a low risk of cross-reactivity, cephalosporins are not recommended in patients with a reported IgE-mediated penicillin allergy.  We assessed the incidence and characteristics of reactions in patients with a reported penicillin allergy prescribed cefazolin perioperatively.

 Methods:

We performed a retrospective analysis in a cohort of morbidly obese patients who received cefazolin perioperatively, evaluating the penicillin allergy history and tolerability of perioperative cefazolin in those with a reported penicillin allergy.  The primary outcome was the occurrence and type of reactions documented within 72 hours of the first perioperative dose.

 Results:

A total of 838 patient encounters were reviewed.  Of these, 89 (11%) patients reported a penicillin allergy.  The documented historical reactions ranged from rash (42%), hives (25%), unknown (12%), itching (4%), and other (4%).  Non-immune mediated reactions were described in eleven (12%) patients. 

Post-cefazolin administration, adverse reactions included gastrointestinal events (12%), itching (2%), shortness of breath (1%), and acute kidney injury (1%).  There was no statistically significant difference in adverse reactions between the penicillin allergy and the non-penicillin allergy groups.  No life-threatening adverse reactions occurred. 

Conclusions:

Our analysis demonstrates the overall safety of perioperative cefazolin in patients with a history of mild to moderate reported penicillin adverse reactions, indicating that use of cefazolin in these patients should be considered in a monitored setting.