From the Guidelines
A patient with a penicillin allergy can generally receive Cefepime, as the risk of cross-reactivity is considered negligible, especially since Cefepime has a distinct side chain that is not similar to penicillins 1. When evaluating the safety of administering Cefepime to a patient with a penicillin allergy, it's crucial to consider the potential for cross-reactivity between beta-lactam antibiotics. However, the most recent and highest quality evidence suggests that the risk of cross-reactivity between penicillins and cephalosporins like Cefepime is very low, particularly when the cephalosporin has a dissimilar side chain to the penicillin in question 1. Key points to consider include:
- The risk of cross-reactivity is negligible (<1%) for cephalosporins with dissimilar side chains to the suspected penicillin 1.
- Cefepime's side chain is not similar to those of penicillins, suggesting a low risk of cross-reactivity.
- A thorough review of the patient's allergy history, focusing on reactions to antibiotics, is essential before administering Cefepime.
- Documenting the nature of previous reactions (e.g., rash, anaphylaxis) is also crucial for safe administration.
- Cefepime is typically dosed at 1-2 grams every 8-12 hours for most infections, with adjustments needed for renal impairment. Given the low risk of cross-reactivity and the importance of effective antibiotic treatment, Cefepime can be considered a viable option for patients with penicillin allergies, provided that a thorough assessment of their allergy history has been conducted 1.
From the FDA Drug Label
Exercise caution if this product is to be given to penicillin-sensitive patients because cross-hypersensitivity among beta-lactam antibiotics has been clearly documented and may occur in up to 10% of patients with a history of penicillin allergy.
A patient with a penicillin allergy can receive Cefepime, but with caution. The FDA drug label warns of potential cross-hypersensitivity among beta-lactam antibiotics, which may occur in up to 10% of patients with a history of penicillin allergy 2.
From the Research
Patient Allergy Considerations
- A patient with a penicillin allergy may be able to receive Cefepime, as the cross-reactivity between penicillin and cephalosporins is relatively low, occurring in about 2% of cases 3.
- The risk of cross-reactivity is higher with first- and second-generation cephalosporins, but newer-generation cephalosporins like Cefepime have a lower risk of cross-reactivity 4.
Cefepime Characteristics
- Cefepime is a fourth-generation cephalosporin antibiotic with an enhanced antibacterial potency and spectrum 5.
- It has been shown to be effective in treating various bacterial infections, including those caused by multiply resistant Enterobacter species 5 and Pseudomonas aeruginosa 6.
- Cefepime can cause side effects, including encephalopathy, especially in elderly patients 7.
Clinical Considerations
- Clinicians should carefully evaluate a patient's allergy history and consider penicillin skin testing or a graded challenge to determine the risk of an allergic reaction to Cefepime 3, 4.
- The decision to use Cefepime in a patient with a penicillin allergy should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 3, 4.
- Cefepime has been shown to be safe and effective in the treatment of adult patients with severe infections, including those with nosocomial infections and underlying medical conditions 6.