Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Beta-Lactam Allergy

Minor Penicillin Allergies

Minor Penicillin Allergies

Nonsepecific or maculopapular rashes, intolerance, etc.

Consider a cephalosporin, such as:

Ceftriaxone

OR

Cefepime

If antipseudomonal coverage is needed

Cross-reactivity with 3rd and 4th generation cephalosporins is low (<3%) in patients with minor penicillin allergies and the benefit from beta-lactam antibiotics outweighs the potential risk in these patients

Serious Penicillin Allergies

Serious Penicillin Allergies

Anaphylaxis, angioedema, breathing problems, and hives

Consider a respiratory fluoroquinolone, such as:

Levofloxacin 750 mg IV Q24h

In the absence of prior exposure to fluoroquinolones in the past 12 months

OR

Ciprofloxacin 400 mg IV Q8h

In the absence of prior exposure to fluoroquinolones in the past 12 months

Can be considered if antipseudomonal coverage is needed, but does not provide adequate gram-positive coverage (e.g. Streptococcus pneumoniae, MRSA) and may need to be coupled with vancomycin

Consider consultation with an infectious diseases specialist or PHASST for optimal empirical therapy or evaluation for penicillin allergy skin testing