![]() 21 However, this study included 12 case reports and excluded patients in whom diagnosis of cross-reactivity was based on a positive ST result, thereby introducing important biases. PENICILLIN ALLERGY CROSS REACTIVITY SKIN15 The elaboration of these guides requires that the risk of cross-reactivity between penicillins and other beta-lactams (cephalosporins and carbapenems) be accurately determined.įew systematic reviews on cross-reactivity to cephalosporins and carbapenems have been published and all have several limitations.16, 17, 18 First, all focus on IgE-mediated reactions,16, 17, 18 providing no information on T-cell–mediated reactions despite their high frequency.19, 20 Second, they all include studies performed on patients with a history of penicillin allergy that was not confirmed by skin test (ST) or a drug provocation test (DPT), introducing a bias that may falsely lower the actual rate of cross-reactivity in penicillin-allergic patients.16, 17, 18 Only the systematic review by Kula et al 16 on cross-reactivity to carbapenems was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 9 The use of second-line antibiotics such as fluoroquinolones and vancomycin, which also carry additional costs, in place of the preferred beta-lactam provides a plausible explanation for these morbidities.6, 9, 10, 11 One way to attenuate these complications is to remove penicillin allergy labels, through allergy testing, in as many patients as possible becausr most will be found to be nonallergic.12, 13, 14 Another way is to provide clinical guides for nonallergists that would facilitate the safe use of beta-lactams in patients with a suspected or proven penicillin allergy. ![]() Increasing antimicrobial resistance is a major and complex public health issue requiring a multifaceted action plan.1, 2 Antimicrobial stewardship programs, by improving the appropriate use of antimicrobials, are one of the main initiatives put forward to tackle this problem.3, 4 An important group of patients that needs to be targeted comprises those allergic to penicillin, who make up around 10% of the adult population.5, 6, 7 These patients are more at risk of being infected by Clostridium difficile or colonized by resistant bacteria such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus.6, 8 In addition, they have higher treatment failure rates for certain types of infections. ![]()
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