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Safety of cefuroxime in patients with confirmed hypersensitivity to penicillins: results of a cohort study

A cohort study in France evaluated the safety of cefuroxime as an alternative in patients with a proven allergy to beta-lactams.

To identify a cohort of patients with demonstrated hypersensitivity to beta-lactams, the Drug Allergy and Hypersensitivity Database (DAHD) was used. From this database, information was collected on patients with beta-lactam intolerance who were examined for their hypersensitivity to cefuroxime from September 1996 to April 2007. When examining the patients, the scientists were guided by the recommendations from the European Drug Allergy Network.

Among 650 patients examined, 143 people (22%) had hypersensitivity to at least one beta-lactam antibiotic, but not to cefuroxime. In 118 patients (82.5%) there was sensitization to penicillin, in 8 (5.6%) to cephalosporins and in 17 patients (11.9%) to penicillins and cephalosporins. Only 9 patients (6.3%) were sensitized to cefuroxime (of which 6 sensitizations were proven by a provocative test): 5 people (55.6%) in the group of allergic reactions to penicillins only and 4 people (44, 4%) a group with intolerance to penicillins and cephalosporins. The incidence of hypersensitivity reactions in patients sensitized to beta-lactams was 6.3% (95% CI 2.3-10.3%) and 4.2% in patients sensitized to penicillin (CI 95%, 0.6 -7.9%). This indicator decreases to 2.9% (95% CI, 0 to 6.9%) in patients with anamnestic hypersensitivity data prior to penicillin only.

Thus, cefuroxime can be a safe alternative antibiotic in patients with allergic reactions to beta-lactams after an appropriate examination. Of course, it should be noted that the risk of allergic reactions to cefuroxime in patients allergic to beta-lactams is, although minimal, but not zero, and therefore provocative tests are necessary.