Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting.

Shumaila Sarfani, Cosby A Stone, G Andrew Murphy, David R Richardson

The Journal of the American Academy of Orthopaedic Surgeons 2022 Jan 01

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Penicillin allergies are reported by 8% to 15% of the US population, but up to 95% of these allergies do not correspond to a true allergy when tested. Recent studies have demonstrated that having a penicillin allergy label (PAL) results in a 50% increased odds of surgical site infection among patients reporting a penicillin allergy entirely attributable to the use of a beta-lactam alternative antibiotic (primarily clindamycin or vancomycin). This study provides a review of the prevalence of PAL, the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool are proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting. Copyright © 2021 by the American Academy of Orthopaedic Surgeons.

Citation

Shumaila Sarfani, Cosby A Stone, G Andrew Murphy, David R Richardson. Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting. The Journal of the American Academy of Orthopaedic Surgeons. 2022 Jan 01;30(1):e1-e5