From the Guidelines
Cross sensitivity between piperacillin-tazobactam (Piptazo) and ceftriaxone is generally low, making it usually safe to administer ceftriaxone to patients with a history of non-severe reactions to piperacillin-tazobactam. These antibiotics belong to different classes—piperacillin-tazobactam is a penicillin/beta-lactamase inhibitor combination, while ceftriaxone is a third-generation cephalosporin. Although both contain beta-lactam rings, the side chains differ significantly, which explains the limited cross-reactivity, as shown in the study published in the Journal of Allergy and Clinical Immunology 1.
Key Points to Consider
- The study published in 2022 provides an updated practice parameter on drug allergy, which includes information on cross-reactivity between different beta-lactam antibiotics 1.
- The estimated cross-reactivity between penicillins and cephalosporins is approximately 2-5%, much lower than previously thought, as reported in the study 1.
- For patients with mild reactions like rash to piperacillin-tazobactam, ceftriaxone can typically be used safely.
- However, caution is warranted in patients with severe reactions such as anaphylaxis, Stevens-Johnson syndrome, or toxic epidermal necrolysis to any beta-lactam.
- In these cases, skin testing or graded challenge protocols under medical supervision may be necessary before administering ceftriaxone, as suggested by the study 1.
Clinical Implications
- The low cross-sensitivity between piperacillin-tazobactam and ceftriaxone allows for the safe use of ceftriaxone in patients with a history of non-severe reactions to piperacillin-tazobactam.
- Clinicians should exercise caution when administering ceftriaxone to patients with severe reactions to any beta-lactam antibiotic.
- The use of ceftriaxone in patients with a history of severe reactions to piperacillin-tazobactam should be guided by the results of skin testing or graded challenge protocols, as recommended by the study 1.
From the Research
Cross-Sensitivity between Piptazo and Ceftriaxone
- There is limited direct evidence on cross-sensitivity between piptazo (piperacillin/tazobactam) and ceftriaxone.
- However, a study on piperacillin-tazobactam hypersensitivity found that one-third of patients were cross-sensitized to other penicillins 2.
- Another study compared the clinical benefits of piperacillin/tazobactam versus a combination of ceftriaxone and clindamycin in treating hospital-acquired pneumonia, but did not specifically address cross-sensitivity 3.
- A trial protocol for a randomized controlled trial comparing meropenem and piperacillin-tazobactam for treating bloodstream infections due to ceftriaxone non-susceptible Escherichia coli and Klebsiella spp. may provide indirect insights into the relationship between these antibiotics, but does not directly address cross-sensitivity 4.
- Overall, the available evidence does not provide a clear answer to the question of cross-sensitivity between piptazo and ceftriaxone, and more research may be needed to fully understand this relationship.
Relevant Studies
- A study on piperacillin-tazobactam hypersensitivity found that patients with cystic fibrosis predominantly presented with nonimmediate hypersensitivity (70%) 2.
- A comparison of piperacillin/tazobactam and cefepime in combination with gentamicin, ciprofloxacin, or levofloxacin against Pseudomonas aeruginosa found that all combinations were bactericidal, but did not address cross-sensitivity 5.
- A retrospective cohort study comparing ceftriaxone plus clindamycin and piperacillin/tazobactam for treating early non-ventilator hospital-acquired pneumonia found that treatment with piperacillin/tazobactam was more effective, but did not address cross-sensitivity 3.
- A systematic review of prolonged vs intermittent infusion of piperacillin/tazobactam in critically ill patients found moderate evidence supporting a better clinical outcome with prolonged infusion, but did not address cross-sensitivity 6.