Is a patient allergic to Cipro (ciprofloxacin), morphine, oxycodone, sulfa (sulfonamides), Vanco (vancomycin), Augmentin (amoxicillin-clavulanate), and codeine able to receive cefepime?

From the Guidelines

Yes, a patient allergic to Cipro (ciprofloxacin), morphine, oxycodone, sulfa (sulfonamides), Vanco (vancomycin), Augmentin (amoxicillin-clavulanate), and codeine can likely receive cefepime.

Key Points

• The risk of cross-reactivity between penicillins and cephalosporins is generally low, especially for cephalosporins with dissimilar side chains to the suspected penicillin 1.
• Cefepime has a unique side chain and is considered to have a low risk of cross-reactivity with penicillins 2, 3.
• The Dutch Working Party on Antibiotic Policy guideline recommends that patients with a non-severe, delayed-type penicillin allergy can receive any monobactam or carbapenem, and possibly cephalosporins like cefepime, without prior allergy testing 4.
• A study found that the risk of cross-reactivity to cephalosporins in patients with proven penicillin allergy varied from 16.45% for aminocephalosporins to 2.11% for low-similarity-score cephalosporins, which includes cefepime 3.
• The 2022 practice parameter update on drug allergy suggests that cefepime can be used in patients with a penicillin allergy, but recommends skin testing and drug challenges to confirm tolerance 2, 5.

Important Considerations

• The patient's specific allergy history and severity of reactions should be taken into account when considering cefepime administration.
• Skin testing and drug challenges may be necessary to confirm tolerance to cefepime in patients with a penicillin allergy.
• Cefepime is a fourth-generation cephalosporin with a broad spectrum of activity, and its use should be guided by local antimicrobial resistance patterns and clinical judgment.

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. Before therapy with cefepime for injection is instituted, careful inquiry should be made to determine whether the patient has had previous immediate hypersensitivity reactions to cefepime, cephalosporins, penicillins, or other drugs

The patient is allergic to Augmentin (amoxicillin-clavulanate), which is a penicillin-based antibiotic. Since there is a possibility of cross-hypersensitivity among beta-lactam antibiotics, including cephalosporins like cefepime, caution should be exercised when administering cefepime to this patient. However, the presence of allergies to Cipro (ciprofloxacin), morphine, oxycodone, sulfa (sulfonamides), Vanco (vancomycin), and codeine does not directly impact the decision to administer cefepime. Given the patient's allergy to a penicillin-based antibiotic, cefepime should be used with caution 6.

From the Research

Allergic Reactions to Antibiotics

• The patient is allergic to Cipro (ciprofloxacin), morphine, oxycodone, sulfa (sulfonamides), Vanco (vancomycin), Augmentin (amoxicillin-clavulanate), and codeine, which are all different classes of antibiotics and medications 7.
• Cefepime is a fourth-generation cephalosporin antibiotic, which is a different class from the antibiotics the patient is allergic to 7.
• There is a concern about cross-reactivity between penicillins and cephalosporins, but this is more relevant for first-generation cephalosporins, and the risk is lower for later-generation cephalosporins like cefepime 8, 9.

Cross-Reactivity between Antibiotics

• Studies have shown that patients with a confirmed allergy to one antibiotic may not necessarily be allergic to other antibiotics in the same class 10, 8.
• The risk of cross-reactivity between sulfonamide antibiotics and non-antimicrobial sulfonamide medications is low 11.
• The patient's allergy to sulfa (sulfonamides) does not necessarily mean they will be allergic to other antibiotics, including cefepime 11.

Management of Antibiotic Allergies

• A detailed allergy history is important when deciding if a patient can receive a drug that may cross-react 7.
• Clinicians should differentiate between adverse drug reactions and antibiotic allergies to provide optimal patient care 9.
• Inappropriate alternative antibiotics are frequently chosen due to patient allergies, which can lead to higher rates of broad-spectrum antibiotic use, antibiotic resistance, and poor outcomes 9.