infectious diseases
Cephalosporins
Contraindications to Cephalosporins
. Cross-reactivity with penicillins and other classes of beta-lactams including other cephalosporins is less common than previously thought, especially among patients who have had mild (nonanaphylactic) reactions to penicillins. About 2% of penicillin-allergic patients have cross-reactivity with cephalosporins ( Contraindications references , Ceftriaxoneis contraindicated as follows: CeftriaxoneIV must not be coadministered with calcium-containing IV solutions (including continuous calcium-containing infusions such as parenteral nutrition) in neonates≤28 days because precipitation ofceftriaxone-calcium salt is a risk. Fatal reactions withceftriaxone-calcium precipitates in the lungs and kidneys of neonates have been reported. To date, no intravascular or pulmonary precipitates have been reported in patients other than neonates who are treated withceftriaxoneand calcium-containing IV solutions. However, because an interaction betweenceftriaxoneand IV calcium-containing solutions is theoretically possible in patients other than neonates,ceftriaxoneand calcium-containing solutions should not be mixed or given within 48 hours of each other (based on 5 half-lives ofceftriaxone)—even via different infusion lines at different sites—to any patient regardless of age. No data on potential interaction betweenceftriaxoneand oral calcium-containing products or on interaction between IMceftriaxoneand calcium-containing products (IV or oral) are available. , potentially triggering Kernicterus . 1.Shenoy ES, Macy E, Rowe T, Blumenthal KG: Evaluation and management of penicillin allergy: A review.JAMA321(2):188–199, 2019. doi: 10.1001/jama.2018.19283 2.Campagna JD, Bond MC, Schabelman E, Hayes BD: The use of cephalosporins in penicillin-allergic patients: A literature review.J Emerg Med42(5):612–620, 2012. doi: 10.1016/j.jemermed.2011.05.035 3.Chaudhry SB, Veve MP, Wagner JL: Cephalosporins: A focus on side chains and β-lactam cross-reactivity.Pharmacy (Basel)7(3):103, 2019. doi: 10.3390/pharmacy7030103 4.Collins CD, Scheidel C, Anam K, et al: Impact of an antibiotic side chain-based cross-reactivity chart combined with enhanced allergy assessment processes for surgical prophylaxis antimicrobials in patients with beta-lactam allergies.Clin Infect Dispii:ciaa232, 2020. doi: 10.1093/cid/ciaa232 5.DePestel DD, Benninger MS, Danziger L, et al: Cephalosporin use in treatment of patients with penicillin allergies.J Am Pharm Assoc (2003)48(4):530–540, 2008. doi: 10.1331/JAPhA.2008.07006 