Reviewed by: David Cluck, PharmD; East Tennessee State University
Zimmer and colleagues evaluated cephalosporin utilization in those with documented intermediate-, high-, and severe-risk allergies following an EHR cross-reactivity alert removal.1
This was a retrospective, observational, quasi-experimental review of patients with a documented intermediate-, high-, or severe-risk penicillin (PCN) allergy who received at least one dose of a systemic antibiotic for an indication in which a cephalosporin was considered first-line. The primary outcome was the rate of cephalosporin utilization. Secondary outcomes included rates of PCN utilization, antibiotic adverse effects, and a composite of treatment failure. Cephalosporin utilization significantly increased after alert removal (27% vs 67%, P < 0.001). Use of cefazolin increased by 47% (P < 0.001), while use of alternative agents, clindamycin and vancomycin, decreased by 12.5% (P = 0.032) and 13.4% (P = 0.021), respectively. The increase in cephalosporin use observed in the post-intervention group was significantly greater among those receiving antibiotics for SSI prophylaxis compared to other indications.
Limited data exist regarding use of cephalosporins in patients with documented intermediate-, high-, or severe-risk allergies (e.g., anaphylaxis and non-IgE-mediated reactions). This study demonstrated that removal of an EHR cross-reactivity alert allowed for cephalosporins to be safely used in patients with intermediate and high-risk PCN allergies. Notably, there was not an increase in cephalosporin use in patients categorized to have severe-risk allergies which would include patients with Stevens-Johnson syndrome or toxic epidermal necrolysis. The general findings of this study are reinforced by a larger dataset which also found increased use of cephalosporins after modifying penicillin allergy EHR alerts.2
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