Is it safe to administer Cefepime (Cefepime) to a patient with allergies to Gentamicin (Gentamicin), Penicillin (Penicillin), and Sulfonamide (Sulfa) antibiotics?

From the Guidelines

Cefepime can generally be given to patients with allergies to gentamicin, penicillin, and sulfa antibiotics, but caution is warranted, particularly in those with severe immediate-type penicillin allergies, with a cross-reactivity risk of approximately 1-3% with cephalosporins like cefepime 1.

Key Considerations

• The risk of cross-reactivity is higher with first-generation cephalosporins than with fourth-generation ones like cefepime.
• There is no cross-reactivity between cefepime and gentamicin (an aminoglycoside) or sulfa antibiotics, as these belong to completely different antibiotic classes with distinct chemical structures.
• Before administering cefepime, it's essential to assess the nature and severity of the penicillin allergy.

Patient Assessment

• For patients with mild penicillin reactions (like rash), cefepime can typically be given safely.
• However, for those with severe reactions like anaphylaxis, angioedema, or Stevens-Johnson syndrome to penicillin, consider consulting with an allergist or infectious disease specialist first.
• If cefepime must be used in high-risk patients, the first dose might be given under medical supervision with emergency medications available.

Evidence Summary

• A recent study published in the Journal of Allergy and Clinical Immunology in 2022 found that the cross-reactivity rate between penicillin and cephalosporins is approximately 1-3% 1.
• Another study from the same year found that carbapenems, a different class of antibiotics, can be administered without testing or additional precautions in patients with a history of penicillin or cephalosporin allergy, with a cross-reactivity rate of less than 1% 1.
• The evidence suggests that cefepime can be safely administered to patients with allergies to gentamicin, penicillin, and sulfa antibiotics, but with caution and careful assessment of the patient's allergy history.

From the FDA Drug Label

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 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.

Key Considerations:

• The patient has allergies to Gentamicin, Penicillin, and Sulfonamide antibiotics.
• Cefepime is a cephalosporin antibiotic, and cross-hypersensitivity among beta-lactam antibiotics (including cephalosporins and penicillins) has been documented.
• However, there is no direct information in the provided drug labels about cross-hypersensitivity between Cefepime and Gentamicin or Sulfonamide antibiotics.

Answer: It is not safe to administer Cefepime to a patient with an allergy to Penicillin without exercising caution, as cross-hypersensitivity may occur. However, the safety of administering Cefepime to a patient with allergies to Gentamicin and Sulfonamide antibiotics cannot be directly determined from the provided information 2, 2.

From the Research

Allergy Considerations

• Patients with allergies to Gentamicin, Penicillin, and Sulfonamide antibiotics may be at risk of cross-reactions with other antibiotics, including Cefepime (a fourth-generation cephalosporin) 3, 4, 5, 6.
• The cross-reactivity between penicillins and cephalosporins is lower than previously reported, with an overall cross-reactivity rate of approximately 1% when using first-generation cephalosporins or cephalosporins with similar R1 side chains 3.
• For penicillin-allergic patients, the use of third- or fourth-generation cephalosporins or cephalosporins with dissimilar side chains than the offending penicillin carries a negligible risk of cross allergy 3, 5.
• Cross-reactivity between sulfa antibiotics and nonantibiotics is rare, but it can affect the pharmacologic and clinical management of patients with sulfa allergy 7.

Cefepime Administration

• Cefepime, being a fourth-generation cephalosporin, is likely to have a low risk of cross-reactivity with penicillins 3, 5, 6.
• However, it is essential to consider the individual patient's allergy history and the severity of their reactions before administering Cefepime 4, 5.
• Clinicians should be familiar with which antibiotics are safe to use for different types of penicillin-allergic reactions and consider antimicrobial therapy with an antibiotic that does not cross-react with penicillins or beta-lactams 4.