Can a patient with allergies to Cipro (ciprofloxacin), sulfa (sulfonamides), Vanco (vancomycin), and Augmentin (amoxicillin-clavulanate) take levofloxacin?

From the Guidelines

The patient with allergies to Cipro (ciprofloxacin), sulfa (sulfonamides), Vanco (vancomycin), and Augmentin (amoxicillin-clavulanate) should not take levofloxacin due to the risk of cross-reactivity with other fluoroquinolones. According to the Dutch Working Party on Antibiotic Policy (SWAB) guideline 1, fluoroquinolone allergy is the most frequently reported non-β-lactam antibiotic allergy, and there is a risk of both immediate and delayed-type allergies to fluoroquinolones. The guideline also notes that moxifloxacin poses the highest risk of anaphylaxis compared to other fluoroquinolones, such as levofloxacin and ciprofloxacin.

The patient's allergy to ciprofloxacin, a fluoroquinolone, increases the risk of a similar reaction to other drugs in the same class, including levofloxacin. The exact risk of cross-reactivity is not specified in the guideline, but it is generally considered to be significant, with some studies suggesting a risk of approximately 50% or higher.

Some key points to consider when evaluating the patient's options include:

• The severity of the previous allergic reactions
• The patient's complete medical history
• The type of infection being treated
• The need for consultation with an infectious disease specialist or allergist to determine safe antibiotic alternatives
• The potential need for antibiotic desensitization protocols if no suitable alternatives exist for a serious infection

Given the patient's multiple antibiotic allergies, it is essential to exercise caution and consider alternative treatment options. The guideline provides a flowchart for approaching non-β-lactam antibiotic allergies, which may be helpful in determining the best course of action 1. Ultimately, the decision to prescribe levofloxacin or any other antibiotic should be made on a case-by-case basis, taking into account the patient's individual needs and medical history.

From the FDA Drug Label

Levofloxacin should be discontinued immediately at the first appearance of a skin rash or any other sign of hypersensitivity Serious acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures, including oxygen, intravenous fluids, antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated Other serious and sometimes fatal events, some due to hypersensitivity, and some due to uncertain etiology, have been reported rarely in patients receiving therapy with fluoroquinolones, including levofloxacin.

The patient has allergies to Cipro (ciprofloxacin), which is also a fluoroquinolone like levofloxacin.

• Hypersensitivity reactions can occur with levofloxacin, and the drug should be discontinued immediately if a patient develops signs of hypersensitivity.
• Given the patient's allergy to Cipro (ciprofloxacin), a fluoroquinolone, it is possible that they may also be allergic to levofloxacin.
• Therefore, it is recommended that the patient avoid taking levofloxacin due to the risk of a hypersensitivity reaction 2.

From the Research

Allergy Considerations

• A patient with allergies to Cipro (ciprofloxacin), sulfa (sulfonamides), Vanco (vancomycin), and Augmentin (amoxicillin-clavulanate) may be able to take levofloxacin, as studies suggest low cross-reactivity between fluoroquinolones 3, 4, 5.
• However, some studies have found a high degree of cross-reactivity among fluoroquinolones, recommending avoidance of the group in patients with hypersensitivity reactions to one fluoroquinolone 6, 7.

Cross-Reactivity Between Fluoroquinolones

• A case report found that a patient with an anaphylactic reaction to ciprofloxacin was tolerant to levofloxacin, as determined by a skin prick test and drug provocation test 3.
• A retrospective chart review found that 2.5% of patients with a history of immediate hypersensitivity reaction to a fluoroquinolone experienced a cross-reaction when exposed to a different fluoroquinolone 4.
• A multicenter study found that patients with a confirmed hypersensitivity reaction to one fluoroquinolone were likely to tolerate other fluoroquinolones, with a low risk of cross-reactivity 5.

Clinical Implications

• The decision to prescribe levofloxacin to a patient with a history of allergy to ciprofloxacin should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 3, 4, 5.
• Clinicians should be aware of the potential for cross-reactivity between fluoroquinolones and consider alternative antibiotic options when necessary 6, 7.