From the Guidelines
Ceftin (cefuroxime) should be avoided in this patient due to the potential risk of cross-reactivity with other cephalosporins and penicillins, as well as the patient's allergy to multiple antibiotics, including cefepime, penicillin, and sulfa. The patient's allergy to cefepime, a cephalosporin antibiotic, increases the risk of reacting to other cephalosporins, such as cefuroxime 1. Additionally, the potential for cross-reactivity between penicillins and cephalosporins, estimated at 5-10% 1, further increases the risk in this patient who is also allergic to penicillin.
Given these multiple antibiotic allergies, it would be prudent to consult with an infectious disease specialist or allergist to determine appropriate antibiotic options for this patient. Alternative antibiotic classes such as macrolides (azithromycin, clarithromycin), fluoroquinolones (ciprofloxacin, levofloxacin), or carbapenems might be considered depending on the infection being treated and the severity of the previous allergic reactions. Aztreonam, a monobactam antibiotic, may also be considered as it has been shown to have no cross-reactivity with penicillins or cephalosporins, except for ceftazidime 1.
The most recent guidelines recommend avoiding cefuroxime for mild skin and soft tissue infections due to the principle of parsimony 1. Instead, alternative antibiotics such as amoxicillin-clavulanic acid, cloxacillin, or cefalexin may be considered as first-line options for mild infections. For more severe infections, such as necrotizing fasciitis, combinations of antibiotics including clindamycin, piperacillin-tazobactam, and vancomycin may be recommended 1.
In summary, the use of Ceftin (cefuroxime) is not recommended in this patient due to the potential risk of cross-reactivity and the availability of alternative antibiotic options. A thorough evaluation of the patient's allergies and medical history, as well as consultation with a specialist, is necessary to determine the most appropriate antibiotic treatment.
From the FDA Drug Label
CONTRAINDICATIONS Cefuroxime for Injection is contraindicated in patients with known allergy to the cephalosporin group of antibiotics.
- Cefuroxime (Ceftin) is a cephalosporin antibiotic.
- The patient is allergic to penicillin, which is also a beta-lactam antibiotic like cephalosporins, and to cefepime, which is another type of cephalosporin.
- Allergies to one type of cephalosporin increase the risk of an allergic reaction to another.
- Therefore, Ceftin should not be used in this patient due to the risk of a potential allergic reaction 2.
From the Research
Allergy Considerations
- The patient is allergic to penicillin, cefepime, daptomycin, doxycycline, and sulfa.
- According to the study 3, cefuroxime (Ceftin) does not increase the risk of an allergic reaction among patients with penicillin allergy.
- The study 4 also suggests that second-generation cephalosporins, such as cefuroxime, have a negligible cross-allergy with penicillins.
Cross-Reactivity
- The overall cross-reactivity rate between penicillins and cephalosporins is approximately 1% when using first-generation cephalosporins or cephalosporins with similar R1 side chains 4.
- However, the study 5 found that the risk of cross-reactivity to cephalosporins varied with the degree of similarity between R1 side chains, with a lower risk associated with cephalosporins having low similarity scores.
- Cefuroxime, being a second-generation cephalosporin, is likely to have a low similarity score and therefore a lower risk of cross-reactivity.
Safety of Using Ceftin
- Based on the studies 3 and 4, it appears that cefuroxime (Ceftin) can be prescribed safely for patients with a penicillin allergy.
- However, it is essential to consider the patient's individual allergy history and the specific cephalosporin being used, as well as the degree of similarity between the R1 side chains 5.
- The study 6 emphasizes the importance of evaluating penicillin allergy before deciding not to use penicillin or other β-lactam antibiotics, which may also apply to the use of cephalosporins like cefuroxime.