Chaudhry Saira B, Veve Michael P, Wagner Jamie L
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA.
Department of Infectious Diseases, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.
Pharmacy (Basel). 2019 Jul 29;7(3):103. doi: 10.3390/pharmacy7030103.
Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1-3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.
由于头孢菌素具有广泛的临床应用价值和普遍的耐受性，它们是最常用的抗生素类别之一，约有1%-3%的人报告对头孢菌素有过敏反应。然而，尽管交叉反应的可能性较低，但临床医生在有青霉素过敏报告的患者中可能会避免使用头孢菌素。β-内酰胺类过敏的误诊以及对β-内酰胺类药物（包括头孢菌素类）之间交叉反应的误解，常常导致使用安全性和有效性较差的广谱抗生素，这对抗菌药物管理构成了严重障碍。头孢菌素过敏的风险因素广泛，包括女性、高龄以及有其他抗生素或青霉素过敏史；然而，即使是对青霉素有真正速发型过敏的个体，也能很好地耐受头孢菌素。头孢菌素的交叉反应可能性与结构R1侧链有关，临床医生在为过敏个体开具替代β-内酰胺类药物时或新头孢菌素上市时，应注意R1侧链的相似性。临床指征明确时，临床医生应考虑真正的头孢菌素过敏可能性较低。本综述的目的是概述头孢菌素在临床实践中的作用，并强调头孢菌素的发生率、风险因素以及与其他抗生素的交叉反应。
