Clinical Pathway for Evaluation/Treatment of Acute Otitis Media in Children 2 Months to 12 Years Old

Allergy Considerations

Rationale for Prescribing Selected Cephalosporins for Penicillin-Allergic Patients*

Patients with a history of "penicillin allergy" actually have an IgE mediated, which should be the main concern for clinicians, allergy in < 10% of cases.

Cephalosporin allergy is primarily related to side chain structure. Cephalosporins that have a side chain structure similar to a penicillin may cross-react, increasing the likelihood of an IgE mediated reaction in penicillin-allergic patients. Cefdinir, Cefpodoxime and Ceftriaxone do not have a side chain structure similar to any of the commonly prescribed penicillins, therefore these specific cephalosporins are safe to use in patients with a history of penicillin allergy.

If a patient has a history of anaphylaxis or other life-threatening reactions to an antibiotic, consult with the attending physician before administering or prescribing any antibiotic.

Types of Allergic Reactions to Penicillins and Cephalosporins*

Immediate (within 1-2 h) IgE mediated
  • Bronchospasm
  • Hypotension
  • Laryngeal edema
  • Local swelling
  • Urticaria
Late (after 24 h)
  • Morbilliform rash
  • Serum sickness
  • Urticaria
Other late reactions
  • Hemolytic anemia
  • Interstitial nephritis
  • Neutropenia
  • Pulmonary infiltration
  • Stevens-Johnson syndrome
  • Thrombocytopenia
  • Vasculitis

Cephalosporins with Side Chains that are Similar to Penicillins

  • Cephalothin
  • Cefoxitin
  • Cephaloridine
  • Side chains similar to Pencillin
  • Cefaclor
  • Cefadroxil
  • Cefprozil
  • Cephalexin
  • Cephatrizine
  • Cephradine
  • Side chains similar to amoxicillin, ampicillin

*Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 2005;115:1048

**Petz LD. Immunologic cross reactions between penicillins and cephalosporins: a review. J Infect Dis 1978(suppl):S74. Roland S et al . Drug Allergy: An Updated Practice Parameter. These parameters were developed by the Joint Task Force on Practice Parameters, representing theAmerican Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma. and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma and Immunology 2010;105:259-273