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Assessing the safety of increased outpatient cephalosporin use following the modification of penicillin allergy cross-reactivity alerts

Published online by Cambridge University Press:  13 March 2025

Bryan Schneider Open the ORCID record for Bryan Schneider [Opens in a new window] ,
Kelly M. Percival Open the ORCID record for Kelly M. Percival [Opens in a new window] ,
Anna M. Rhinehart ,
Jared Frye ,
Deanna L. McDanel ,
Kevin L. Bebout ,
Lukasz D. Weiner Open the ORCID record for Lukasz D. Weiner [Opens in a new window] ,
Sarah A. Auerbach ,
Amy M. Dowden  and
Dilek Ince Open the ORCID record for Dilek Ince [Opens in a new window]
...Show all authors
Bryan Schneider*
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA College of Pharmacy, University of Iowa, Iowa City, IA, USA
Kelly M. Percival
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA
Anna M. Rhinehart
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA
Jared Frye
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA
Deanna L. McDanel
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA Department of Internal Medicine, Division of Allergy and Immunology, University of Iowa, Iowa City, IA, USA
Kevin L. Bebout
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA
Lukasz D. Weiner
Affiliation:
Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Iowa, Iowa City, IA, USA
Sarah A. Auerbach
Affiliation:
Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Iowa, Iowa City, IA, USA
Amy M. Dowden
Affiliation:
Department of Internal Medicine, Division of Allergy and Immunology, University of Iowa, Iowa City, IA, USA
Dilek Ince
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Iowa, Iowa City, IA, USA
Patrick Kinn
Affiliation:
Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA, USA
*
Corresponding author: Bryan Schneider; Email: [email protected]
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Abstract

Background:

Concerns about penicillin-cephalosporin cross-reactivity have historically led to conservative prescribing and avoidance of cephalosporins in patients with penicillin allergy labels, potentially causing suboptimal outcomes. Recent evidence suggests a lower risk of cross-reactivity, prompting a reassessment of alert systems.

Objective:

To assess the impact of limited penicillin cross-reactivity alerts on outpatient cephalosporin use and the incidence of adverse reactions in a healthcare setting.

Methods:

This retrospective cohort study compared cephalosporin prescribing and adverse reactions in patients labeled as penicillin-allergic before and after limiting penicillin cross-reactivity alerts in the electronic medical record at a large academic medical center.

Results:

Among 17,174 patients (8,131 pre- and 9,043 post-implementation), there was a statistically significant increase in outpatient cephalosporin prescribing by 8% (P < .001). The use of alternative antibiotic classes decreased. There was no statistically significant increase in adverse events pre- and post-implementation (0.036%–0.058%, P = .547), and no severe events were attributable to cross-reactivity. The alert modification reduced alerts by 92% (P < .001).

Conclusion:

The reduction of penicillin-cephalosporin cross-reactivity alerts was associated with increased cephalosporin use, without a significant increase in adverse reactions. This demonstrates that the practice is safe and decreases alert burden.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 4 , April 2025 , pp. 416 - 421
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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