Beta-Lactam Allergy Management

Initial Steps

Avoid the unnecessary use of antimicrobials, particularly in the setting of viral infections

Complete a thorough investigation of the patient’s allergies, including, but not limited to:

  • The specific drug the patient received

  • A detailed description of the reaction

  • Temporal relationship of the onset of the reaction with respect to when the drug was given

  • Concomitant drugs received when the reaction occurred

  • The time elapsed since the reaction occurred and tolerability of any structurally related compounds

Reported Reaction & Management

E.g. nausea, vomiting, diarrhea, headache, etc.

Recommendation

  • likely not allergic

  • attempt beta-lactam therapy

E.g. interstitial nephritis, immune hepatitis, hemolytic anemia, serum sickness, severe cutaneous reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), etc.

Recommendation:

  • Avoid all beta-lactam antibiotics including their use for allergy testing, desensitization and re-challenge

  • Treatment options include non-beta-lactam antibiotics

E.g. anaphylaxis, urticaria, angioedema, hypotension, bronchospasm, stridor, pruritis

Recommendation:

  • Avoid other penicillins and cephalosporins with similar side chain, unless patient undergoes desensitization

  • Treatment options include cephalosporins with dissimilar side chains, carbapenems, or non-betalactam antibiotics. (Note: ceFAZolin does not share a side chain with any beta-lactam agent)

E.g. Anaphylaxis, urticaria, angioedema, hypotension, bronchospasm, stridor, pruritis

Recommendation:

  • Avoid cephalosporins and penicillins with similar side chains unless desensitization is performed

  • Treatment options include penicillins or cephalosporins with dissimilar side chains, carbapenems, or non-beta-lactam antibiotic