He holds a BS degree in pharmacy and a PhD degree in pharmacology. He is the lead author of the Drug Information Handbook for Dentistryco-author of many asa and cephalexin cross sensitivity dental drug publications, asa and cephalexin cross sensitivity, author of over refereed scientific journal articles, consultant to the Academy of General Dentistry, featured columnist, and a featured speaker presenting more than courses in continuing dental education.
One of his primary interests continues to be keeping dental professionals informed of all aspects of drug use in dental practice. The authors concluded that there is limited correlation between allergy to a penicillin antibiotic and allergy to a cephalosporin antibiotic.
Cross reactivity between penicillins and cephalosporins is overestimated and much lower than reported in early studies. Before the s, drug companies used the Acremonium bacterium species to create both penicillins and cephalosporins. It is felt that contamination of the cephalosporins with the penicillin during this manufacturing process may be responsible for those early reports of the relatively high incidences of cross-allergic reactions.
Another reason for the belief in a high rate of cross reactivity was the chemical similarities between penicillins and cephalosporins. The chemical structures of each contain the important beta-lactam ring with various carbon side chains attached. Asa and cephalexin cross sensitivity side chains can be similar or vastly different, depending on the specific penicillin and cephalosporin.
Similarities in those carbon side chains, according to the authors, correlate with the risk for cross reactivity. They cite studies showing that the type of side chain off the beta-lactam ring is the determining factor for the rate of cross reactivity. Amoxicillin and ampicillin have the same side chain as several first- and second-generation cephalosporins. Therefore, the authors caution that patients confirmed to be selectively asa and cephalexin cross sensitivity to amoxicillin or ampicillin should not be given those cephalosporins asa and cephalexin cross sensitivity similar side chains.
These cephalosporins are as follows:. The authors also mention that skin testing in penicillin-allergic patients cannot reliably predict an allergic response to cephalosporins. They cite published reports and data from pharmaceutical companies that skin testing may be useful in determining whether a true allergy to penicillin exists, but may not predict a blood pressure and echinacia reactivity to cephalosporins.
The authors performed a literature search of MEDLINE from to the present using search terms such as penicillins; cephalosporins; allergy, cross-react; hypersensitivity, immediate; and hypersensitivity, delayed. Articles determined to be appropriate for the review, based on relevance to the clinical question, were collected, asa and cephalexin cross sensitivity. From those 67 articles, 40 were excluded as either review articles, letters to the editor, or background chemistry reports.
The selected 27 articles were evaluated for their level of evidence and methodology by at least two of the authors using literature review guidelines published by the American Academy of Emergency Medicine. The study described in each article was then assigned a ranking of outstanding, good, adequate, poor, or unsatisfactory based on the level of evidence and methodology.
When a patient has a history of anaphylaxis to penicillin, caution should be used as cross reactivity is always possible, and patients should be monitored closely with introduction of a cephalosporin, asa and cephalexin cross sensitivity. Cefuroxime Ceftin tablets is a second-generation orally available cephalosporin having a different beta-lactam side chain from penicillin and meets the criteria mentioned by the study authors of a cephalosporin that could be used in penicillin-allergic patients.
The orally available third generations that also meet the criteria include: In general, third-generation cephalosporins are more specific to anaerobic bacteria and more expensive than second-generation agents. Lexicomp Home View Archived Articles. Share this article Lexicomp on Facebook Lexicomp on Twitter.