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Oral antibiotic adverse reactions after penicillin skin testing: multi-year follow-up

E Macy1, R J Burchette

  • 1Department of Allergy, Kaiser Permanente Southern California, USA.

Allergy
|December 5, 2002
PubMed
Abstract

Insights

Penicillin skin testing accurately identifies individuals at risk for penicillin allergies. Cephalosporins are a safer alternative to non-beta-lactams for patients with or without penicillin allergies, reducing adverse drug reactions.

Area of Science:

  • Clinical Allergy and Immunology
  • Pharmacovigilance
  • Infectious Diseases

Background:

  • Data on adverse drug reactions (ADRs) following oral antibiotic use in individuals with a history of penicillin allergy, who have undergone penicillin skin testing, are limited.
  • Understanding ADRs is crucial for safe antibiotic prescribing, especially in penicillin-allergic populations.

Purpose of the Study:

  • To evaluate and compare the incidence of ADRs associated with different oral antibiotic classes in individuals with and without penicillin allergy, as determined by skin testing.
  • To assess the long-term safety of cephalosporins and non-beta-lactam antibiotics in these patient groups.

Main Methods:

  • A cohort study comparing 83 penicillin skin test-positive individuals with 166 matched penicillin skin test-negative individuals.
  • All participants received at least one oral antibiotic post-skin testing, with a mean follow-up of 34.5 months and 1655 total antibiotic exposures.
  • Adverse drug reactions were recorded and compared between groups and antibiotic classes (cephalosporins, non-beta-lactams, penicillins).

Main Results:

  • No significant difference in ADR rates was observed between cephalosporin and non-beta-lactam use in penicillin skin test-positive individuals (P = 0.12).
  • Cephalosporin use was associated with significantly fewer ADRs compared to non-beta-lactams in penicillin skin test-negative individuals (P = 0.005).
  • Overall, cephalosporins demonstrated fewer ADRs than non-beta-lactams, irrespective of penicillin skin test status (P = 0.005).

Conclusions:

  • Penicillin skin testing effectively predicted penicillin-associated ADRs only in positive individuals.
  • Non-beta-lactam antibiotics were linked to more ADRs than penicillins or cephalosporins, independent of penicillin skin test results, excluding accidental penicillin exposure.
  • Cephalosporins proved to be as safe as or safer than non-beta-lactams in both penicillin skin test-positive and negative individuals.

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