Penicillin allergy is common in primary care. I am often reluctant to use a cephalosporin in these individuals, especially when better alternatives exist. Are there guidelines or recommendations for the use of cephalosporins in patients allergic to penicillin? — John Rice, PA-C, Dunbar, W. Va.

A recent literature review of the use of cephalosporins in penicillin-allergic patients looked at all studies publishing evidence of cross-reactivity from 1950 through 2011. The odds ratio (OR) of cross-reactivity with first-generation cephalosporins is significant (OR 4.8; confidence interval [CI] 3.7-6.2), but is not significant with later-generation cephalosporins (OR 1.1; CI 0.6-2.1).

This correlates with a 1% risk of cross-reactivity with first-generation cephalosporin use and substantially less with other cephalosporins. The authors concluded that the risk with later-generation cephalosporins is negligible, but fell short of recommending their use if another alternative is available. (J Emerg Med. 2012;42:612-620). — Claire Babcock O’Connell, MPH, PA-C (173-4)

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