From the Guidelines
Cefdinir is generally considered safe for most patients with a penicillin allergy, with a negligible risk of cross-reactivity, as supported by recent studies 1. For patients with a mild penicillin allergy, cefdinir is typically safe to use. However, for patients with a history of severe penicillin allergies, such as anaphylaxis, angioedema, or Stevens-Johnson syndrome, caution is still warranted. The risk of cross-reactivity between penicillins and cephalosporins, including cefdinir, is lower than historically reported, with recent estimates suggesting a cross-reactivity rate of around 2-4.8% 1. Key factors to consider when evaluating the safety of cefdinir in patients with a penicillin allergy include:
- The severity of the penicillin allergy
- The specific type of penicillin allergy (e.g., rash, anaphylaxis)
- The presence of any other allergies or medical conditions
- The availability of alternative antibiotics In general, cefdinir can be considered a safe option for patients with a penicillin allergy, but it is essential to carefully evaluate each patient's individual situation and medical history before making a decision. As noted in a recent study, cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 2. Therefore, cefdinir can be a viable treatment option for patients with a penicillin allergy, but close medical supervision and careful monitoring for any signs of an allergic reaction are still necessary.
From the FDA Drug Label
WARNINGS BEFORE THERAPY WITH CEFDINIR IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFDINIR, OTHER CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS IF CEFDINIR IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS-HYPERSENSITIVITY AMONG β-LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY.
Cefdinir is not absolutely safe in patients with a penicillin allergy, as cross-hypersensitivity among β-lactam antibiotics, including cefdinir and penicillins, has been documented and may occur in up to 10% of patients with a history of penicillin allergy.
- Caution should be exercised when administering cefdinir to penicillin-sensitive patients. 3
From the Research
Cefdinir Safety in Patients with Penicillin Allergy
- Cefdinir is a third-generation cephalosporin, and according to the study 4, third- or fourth-generation cephalosporins or cephalosporins with dissimilar side chains than the offending penicillin carry a negligible risk of cross allergy.
- The overall cross-reactivity rate between penicillins and cephalosporins is approximately 1% when using first-generation cephalosporins or cephalosporins with similar R1 side chains 4.
- Another study 5 states that cefprozil, cefuroxime, cefpodoxime, ceftazidime, and ceftriaxone do not increase the risk of an allergic reaction, but it does not specifically mention cefdinir.
- However, based on the information provided, it can be inferred that cefdinir, being a third-generation cephalosporin, is likely to be safe for patients with a penicillin allergy, as the cross-reactivity between penicillins and third-generation cephalosporins is low 4, 5.
- It is essential to note that patients with a history of anaphylaxis, positive penicillin skin testing, recurrent penicillin reactions, or hypersensitivities to multiple β-lactam antibiotics are at high risk for developing an allergic reaction to penicillin and should be evaluated carefully before administering cefdinir 6.