Open AccessUnderstanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting
Author(s) -
Shumaila Sarfani,
Cosby A. Stone,
G. Andrew Murphy,
David R. Richardson
Publication year - 2021
Publication title -
journal of the american academy of orthopaedic surgeons
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.343
H-Index - 111
eISSN - 1095-8762
pISSN - 1067-151X
DOI - 10.5435/jaaos-d-21-00422
Subject(s) - medicine , cefazolin , penicillin , penicillin allergy , allergy , antibiotics , clindamycin , intensive care medicine , population , immunology , environmental health , microbiology and biotechnology , biology
Penicillin allergies are reported by 8% to 15% of the US population, but up to 95% of these allergies do not correspond to a true allergy when tested. Recent studies have demonstrated that having a penicillin allergy label (PAL) results in a 50% increased odds of surgical site infection among patients reporting a penicillin allergy entirely attributable to the use of a beta-lactam alternative antibiotic (primarily clindamycin or vancomycin). This study provides a review of the prevalence of PAL, the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool are proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting.