YLIHERKKYYS PENISILLIINILLE

[Bb]

Lähettäjä: Soijuv Lähetetty: 29.3.2006 7:13

Penisilliinille yliherkillä henkilöillä on pieni riski saada yliherkkyysreaktioita myös kefalosporiineista (yleisiä antibiootteja borrelioosin hoidossa) ja sufonamideista. Anafylaktisen shokin mahdollisuss on kuitenkin erittäin pieni joten tutkimuksen mukaan kefalosporiineja voidaan käyttää penisilliinille yliherkille henkilöille.


doi:10.1016/j.amjmed.2005.10.052 How to Cite or Link Using DOI (Opens New Window)
Copyright © 2006 Elsevier Inc. All rights reserved.

Clinical research study

Is There Cross-Reactivity Between Penicillins and Cephalosporins?

Andrea J. Apter MD, MSca, b, c, Corresponding Author Contact Information, E-mail The Corresponding Author, Judith L. Kinman MAb, Warren B. Bilker PhDb, d, Maximilian Herlimb, David J. Margolis MD, PhDb, d, e, Ebbing Lautenbach MD, MPH, MSCEb, d, f, Sean Hennessy PharmD, PhDb, c, d and Brian L. Strom MD, MPHb, c, d

aDivision of Pulmonary, Allergy Critical Care Medicine, Department of Medicine, Philadelphia, Pa.
bCenter for Clinical Epidemiology and Biostatistics and Center for Education and Research on Therapeutics, Philadelphia, Pa.
cLeonard Davis Institute of Health Economics, Philadelphia, Pa.
dDepartment of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa.
eDepartment of Dermatology, University of Pennsylvania, Philadelphia, Pa.
fDivision of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pa.

Received 24 May 2005; accepted 14 October 2005. Available online 27 March 2006.

Abstract

Background

We sought to determine the risk of an allergic reaction to a cephalosporin exposure in those with prior penicillin reactions.

Methods

We conducted a retrospective cohort study using the United Kingdom General Practice Research Database. We selected all patients receiving a prescription for penicillin followed by a prescription for a cephalosporin and identified allergic-like events within 30 days after each prescription. Allergic events were defined by 2 sets of codes: 1 more restrictive, 1 more inclusive. Comparison was made with a population of patients receiving a prescription for a penicillin followed by a prescription for a sulfonamide antibiotic.

Results

A total of 3 375 162 patients received a penicillin; 506 679 (15%) received a subsequent cephalosporin. Among patients receiving a penicillin followed by a cephalosporin, the unadjusted risk ratio of an allergic-like event for those who had a prior event, compared with those who had no such prior event, narrowly defined, was 10.1 (confidence interval 7.4-13.8 ). The absolute risk of anaphylaxis after a cephalosporin was less than 0.001%. The unadjusted risk ratio for sulfonamide antibiotic, rather than cephalosporin after penicillin allergic-like events was 7.2 (confidence interval 3.8-13.5).

Conclusion

Patients with allergic-like events after penicillin had a markedly increased risk of events after either subsequent cephalosporins or sulfonamide antibiotics. Cross-reactivity is not an adequate explanation for this increased risk, and the risk of anaphylaxis is very low. Thus, our data indicate that cephalosporins can be considered for patients with penicillin allergy.

Keywords: Antibiotic allergy; Adverse drug reaction; Drug hypersensitivity; Penicillin; Cephalosporin