What are the medical errors and management strategies for a 47-year-old male patient who developed a severe allergic reaction to Cefuroxime (Cefuroxime) Intravenous (IV) administered in error instead of Ciprofloxacin (Ciprofloxacin) IV for a Urinary Tract Infection (UTI)?

From the Guidelines

The patient who developed a severe allergic reaction to Cefuroxime IV administered in error instead of Ciprofloxacin IV for a UTI should be managed with caution, and all beta-lactam antibiotics should be avoided due to the risk of cross-reactivity 1.

Medical Errors

• The medical error in this case was the administration of Cefuroxime instead of Ciprofloxacin, which highlights the importance of double-checking medication orders before administration.
• The error also emphasizes the need for clear communication among healthcare professionals to prevent such mistakes.

Management Strategies

• The patient should be handled according to advice provided by an allergist 1, and all beta-lactam antibiotics should be avoided due to the risk of cross-reactivity.
• Alternative antibiotics such as fluoroquinolones (e.g., Ciprofloxacin), aminoglycosides (e.g., Gentamicin), or macrolides (e.g., Clarithromycin) can be considered for the treatment of the UTI, depending on the patient's allergy history and the severity of the reaction.
• Aztreonam can be used in patients with a suspected immediate-type allergy to cephalosporins other than ceftazidime or cefiderocol, irrespective of severity and time since the index reaction 1.
• Carbapenems can be used in a clinical setting in patients with suspected immediate-type allergy to a cephalosporin, irrespective of severity or time since the index reaction 1.
• Penicillins can be used in a clinical setting in patients with a suspected immediate-type allergy to monobactams or carbapenems and no history of penicillin allergy 1.

Key Considerations

• The patient's allergy history should be thoroughly evaluated, and any previous allergic reactions to antibiotics should be documented.
• Skin testing and drug challenges can be used to assess the patient's allergy to specific antibiotics, but these tests should be performed in a controlled setting with trained personnel 1.
• The patient should be closely monitored for any signs of an allergic reaction, and emergency equipment should be readily available in case of an anaphylactic reaction.

From the FDA Drug Label

WARNINGS BEFORE THERAPY WITH CEFUROXIME FOR INJECTION IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF AN ALLERGIC REACTION TO CEFUROXIME FOR INJECTION OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE EPINEPHRINE AND OTHER EMERGENCY MEASURES

The medical error in this case is the administration of Cefuroxime IV instead of Ciprofloxacin IV for a Urinary Tract Infection (UTI), resulting in a severe allergic reaction.

• The management strategy for this error includes:
  • Discontinuation of Cefuroxime IV
  • Administration of epinephrine and other emergency measures for serious acute hypersensitivity reactions
  • Monitoring for potential complications such as Clostridioides difficile associated diarrhea (CDAD) 2 The key steps are to immediately address the allergic reaction and prevent further complications.

From the Research

Medical Errors

• The administration of Cefuroxime IV instead of Ciprofloxacin IV for a Urinary Tract Infection (UTI) is a medical error that can lead to severe allergic reactions 3.
• Medical errors are common and can lead to patient harm and death, with diagnostic, drug, and testing errors being common types of errors in the outpatient setting 3.
• In this case, the error was a drug error, which can be prevented with appropriate education and training of staff members, creation of a culture of safety, and use of technologies to prevent errors 3, 4.

Management Strategies

• When a medical error is discovered, it is essential to disclose the error to the patient, investigate the cause, and provide feedback to prevent similar errors in the future 5.
• The management of a severe allergic reaction to Cefuroxime IV would involve immediate discontinuation of the medication, administration of epinephrine and other medications to alleviate symptoms, and close monitoring of the patient's condition 6.
• Strategies to prevent medical errors include education on medical errors and medical error reporting, posting banners and posters about the subject, using social networks to create a culture of safety, revising incident/error reporting systems, and conducting patient safety symposiums 4.

Treatment of UTI

• Ciprofloxacin is a commonly used antibiotic for the treatment of UTIs, while Cefuroxime is not typically used for this indication 7.
• A study comparing cefpodoxime and ciprofloxacin for the treatment of acute uncomplicated cystitis found that cefpodoxime did not meet criteria for noninferiority for achieving clinical cure 7.
• The use of Cefuroxime IV instead of Ciprofloxacin IV for a UTI would not be an appropriate treatment and could lead to treatment failure and increased risk of complications.