Sir Charles Gairdner Hospital, Level 1, G Block, Hospital Avenue, Nedlands, WA 6009, Australia
Department of Pharmacology, University of Western Australia, Crawley, WA, Australia.
Br J Anaesth. 2016 Oct;117(4):464-469. doi: 10.1093/bja/aew274. Epub 2016 Oct 17.
The most common trigger for intraoperative anaphylaxis in Western Australia for the period 2014-5 was an antibiotic used for surgical prophylaxis, cefazolin. In these patients who subsequently present for surgery, alternative cephalosporins are forbidden by current guidelines because of concerns regarding an increased risk of anaphylaxis. However, consideration of the structure-activity relationships relevant to anaphylaxis suggests that cefalotin is a safe alternative because of structural dissimilarities, although there are no pubished clinical data relevant to the perioperative setting.
Patients diagnosed with intraoperative anaphylaxis to cefazolin at the Western Australian Anaesthetic Allergy Clinic were tested with intradermal cefalotin and, if negative, subsequently challenged i.v. If tolerated, cefalotin was recommended for subsequent surgery, and subjects were followed up to determine the safety of subsequent intraoperative doses.
Twenty-one subjects diagnosed with immediate hypersensitivity to cephazolin, including 19 subjects with confirmed anaphylaxis, participated. None tested positive to intradermal cefalotin, and all received a graded i.v. challenge to cefalotin without developing signs or symptoms of anaphylaxis. Three subjects subsequently received intraoperative cefalotin 12-139 days later without adverse events.
A negative intradermal cefalotin skin test has a good negative predictive value in patients who have previously suffered anaphylaxis to cefazolin, allowing the rational and desirable use of this alternative cephalosporin for future surgery and the avoidance of less desirable antimicrobial agents.
2014-2015 年期间，西澳大利亚州术中过敏反应最常见的诱因是用于手术预防的抗生素，头孢唑林。由于担心过敏反应风险增加，目前的指南禁止这些随后接受手术的患者使用其他头孢菌素。然而，考虑到与过敏反应相关的结构-活性关系，头孢噻吩由于结构上的差异，被认为是一种安全的替代药物，尽管没有与围手术期相关的已发表的临床数据。
在西澳麻醉过敏诊所被诊断为对头孢唑林术中过敏的患者接受头孢噻吩皮内测试，如果为阴性，随后进行静脉内挑战。如果耐受，推荐头孢噻吩用于随后的手术，并且对受试者进行随访以确定随后术中剂量的安全性。
21 名被诊断为对头孢唑林立即过敏的患者（包括 19 名过敏反应确诊患者）参加了研究。没有人对头孢噻吩皮内测试呈阳性反应，所有人都接受了头孢噻吩的分级静脉内挑战，没有出现过敏反应的迹象或症状。随后有 3 名患者在 12-139 天后接受了术中头孢噻吩治疗，没有不良事件发生。
对于以前对头孢唑林发生过敏反应的患者，头孢噻吩皮内测试阴性具有良好的阴性预测值，允许合理且理想地使用这种替代头孢菌素进行未来的手术，并避免使用不太理想的抗菌药物。
