Assessing Need for Alternative Antibiotics in Children with β-Lactam Allergies

Penicillin Allergy – Assess nature of reaction based on Penicillin Allergy Pathway Penicillin allergy is defined as an allergy to a penicillin family antibiotic, including penicillin, ampicillin, amoxicillin, and piperacillin
Symptoms of Allergic Reaction	Recommended First-Line Antibiotic	Action
Reaction consistent with severe cutaneous adverse reaction (e.g., Stevens-Johnson, DRESS)	All penicillins (amoxicillin, ampicillin, piperacillin-tazobactam), cephalosporins, and carbapenems	Use alternative recommendation for initial empiric treatment. Consult Allergy and/or ID if use of a β-lactam is optimal for definitive treatment.
Reaction consistent with immediate hypersensitivity reaction (e.g., hives, bronchospasm, swelling, anaphylaxis)	Penicillins (amoxicillin, ampicillin, piperacillin-tazobactam)	Use alternative recommendation
	Cephalexin	Anaphylaxis: use alternative recommendation Rash alone (including hives): cephalexin
	Cefazolin, ceftazidime, ceftriaxone, or cefepime	Use first-line recommendation
	All carbapenems	Use first-line recommendation

Cephalosporin Allergy
Symptoms of Allergic Reaction	Recommended First-Line Antibiotic	Action
Reaction consistent with severe cutaneous adverse reaction (e.g., Stevens-Johnson, DRESS)	All penicillins (amoxicillin, ampicillin, piperacillin-tazobactam), cephalosporins, and carbapenems	Use alternative recommendation for initial empiric treatment. Consult Allergy and/or ID if use of a β-lactam is optimal for definitive treatment.
Reaction consistent with immediate hypersensitivity reaction (e.g., hives, bronchospasm, swelling, anaphylaxis)	All cephalosporins	Anaphylaxis: Use alternative recommendation for initial empiric treatment. Consult Allergy and/or ID if use of a cephalosporin is optimal for definitive treatment. Rash alone (including hives): Inpatient/ICU: No side chain similarity to culprit cephalosporin: give first-line cephalosporin. Side chain similar to culprit cephalosporin: use alternative recommendation for initial empiric treatment. Consult Allergy and/or ID if use of cephalosporin is optimal for definitive treatment. Outpatient/ED: Use alternative regardless of side chain and then refer to Allergy as outpatient.
	All penicillins (amoxicillin, ampicillin, piperacillin-tazobactam)	Anaphylaxis: use alternative recommendation Rash alone (including hives): use first-line recommendation
	All carbapenems	Use first-line recommendation

β-Lactam Cross Reactivity Table

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Assessing Need for Alternative Antibiotics in Children with β-Lactam Allergies

Assessing Need for Alternative Antibiotics in Children with β-Lactam Allergies