![]() While the core structure is the same for ß-lactams, changes in position 7 of the β-lactam ring are what differentiates the spectrum of activity for each of the cephalosporin generations. ![]() In general, there are six different generations of cephalosporins, and drugs in each generation are used in different indications. Indications Where Cephalosporins are First Line TherapiesĬephalosporins are a class of antibiotics routinely used for a variety of infections, many of which are recommended first line therapies in North American Infectious Diseases society guidelines such as the Infectious Diseases Society of America (IDSA). The objective of this review is to discuss indications where cephalosporin antibiotics are first line therapies, the incidence of cephalosporin allergies, risk factors, and cross-reactivity among cephalosporins and with other β-lactam antibiotics.Ģ. Additionally, desensitization protocols to cephalosporins are not standardized, and test dosing with either an oral or intravenous (IV) administration may not yield accurate results. Unfortunately, there are no reliable testing mechanisms to confirm a cephalosporin allergy in a patient. Thus, an allergy to a cephalosporin in one generation may not have any cross-reactivity to another cephalosporin within the same or different generation if the side chains are different. Īmong the various cephalosporin generations, each carries different risks for eliciting an allergic reaction, which is primarily driven by the R1 side chain. Since optimal treatment in bacterial infections is often directly associated with improved patient outcomes, and that cephalosporins are often regarded as preferred therapies in many infections, barriers to receiving optimal antibiotics are an important target for antimicrobial stewardship intervention. Previous literature has demonstrated that for general infections, patients with β-lactam allergies are more likely to receive suboptimal therapy, experience clinical failure, have an increased hospital length of stay, develop drug resistant organisms, and have higher in-hospital mortality. Most literature suggests that 99% of these patients do not have a true allergy and can safely receive β-lactam antibiotics. Additionally, true IgE-mediated allergies are relatively rare and electronic medical record descriptions of β-lactam allergies are often lacking or incomplete. Common clinical practice is to avoid other β-lactam classes, including cephalosporins, in patients with a labeled β-lactam allergy. While only 1–3% of the population report a cephalosporin allergy, patient-reported or poorly described β-lactam allergies represent a barrier to receiving cephalosporin therapy due to misconceptions related to cross-reactivity. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.Ĭephalosporins are a commonly prescribed class of antibiotics in inpatient and community settings due to their clinical utility in a number of infectious disease states. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy.
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