Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting

Overview

Journal J Am Acad Orthop Surg

Publisher Wolters Kluwer

Specialties General Surgery
Orthopedics

Date 2021 Oct 20

PMID 34669610

Citations 5

Authors

Shumaila Sarfani

Cosby A Stone Jr

G Andrew Murphy

David R Richardson

Affiliations

Soon will be listed here.

Abstract

Penicillin allergies are reported by 8% to 15% of the US population, but up to 95% of these allergies do not correspond to a true allergy when tested. Recent studies have demonstrated that having a penicillin allergy label (PAL) results in a 50% increased odds of surgical site infection among patients reporting a penicillin allergy entirely attributable to the use of a beta-lactam alternative antibiotic (primarily clindamycin or vancomycin). This study provides a review of the prevalence of PAL, the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool are proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting.

Citing Articles

Pre-Operative Management of the Penicillin Allergic Patient: A Narrative Review.

Hernandez A, Davila Y, Nikirk J, Ramirez C, Caudle K, Young P Orthop Rev (Pavia). 2025; 16():124336.

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Evaluation of cephalosporin allergy: Survey of drug allergy experts.

Brameli A, Stone Jr C, Phillips E J Allergy Clin Immunol Glob. 2024; 4(1):100351.

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Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines.

Petousis S, Angelou P, Almperis A, Lagana A, Titilas G, Margioula-Siarkou C J Pers Med. 2024; 14(3).

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Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship.

Anwar F, Roca A, Khosla I, Medakkar S, Loya A, Federico V N Am Spine Soc J. 2023; 16:100278.

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