Cefazolin versus Alternative Antibiotics for Surgical Prophylaxis in Children With a Reported Penicillin Allergy

Area of Science:

• Pediatric Surgery
• Infectious Disease
• Clinical Pharmacology

Background:

• Cefazolin is the preferred antibiotic for preventing surgical site infections in pediatric procedures.
• Patients with penicillin allergies often receive vancomycin or clindamycin, potentially leading to poorer outcomes.
• Concerns exist regarding the safety and efficacy of alternative antibiotics in pediatric surgical prophylaxis.

Purpose of the Study:

• To compare the risk of new drug allergies in children receiving cefazolin versus vancomycin or clindamycin for surgical prophylaxis.
• To evaluate the incidence of adverse drug reactions associated with cefazolin and alternative antibiotics in a pediatric population.
• To inform clinical practice regarding antibiotic selection for surgical prophylaxis in children, particularly those with reported allergies.

Main Methods:

• Retrospective review of pediatric patients (0-18 years) undergoing orthopedic, cardiac, neurosurgical, or plastic surgery.
• Analysis included patients where cefazolin was indicated for surgical prophylaxis.
• Adverse drug reactions were tracked from the preoperative dose up to 7 days post-surgery.

Main Results:

• A total of 46,418 patients were analyzed; 89.6% received cefazolin.
• Only 0.02% of patients on cefazolin experienced adverse reactions, with no prior penicillin allergy history.
• Adverse reactions were significantly more likely with clindamycin (7 times) and vancomycin (56.8 times) compared to cefazolin.

Conclusions:

• Adverse drug reactions to cefazolin in children are rare.
• Reactions to alternative antibiotics (vancomycin, clindamycin) are more common in pediatric surgical prophylaxis.
• Cefazolin should be considered for all indicated pediatric surgical prophylaxis, irrespective of penicillin allergy history, unless a specific cefazolin allergy exists.