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Cefazolin is the recommended antibiotic for surgical prophylaxis and can be used safely in the majority of patients with penicillin allergy, including anaphylaxis¹
Cefazolin has unique side chains unlike any currently marketed penicillins or cephalosporins, making cross-reactivity highly unlikely. Anaphylaxis to cefazolin is uncommon, occurring in 0.0006% of surgical patients² ³
Alternative pre-operative antibiotic regimens are associated with increased surgical site infections and adverse effects compared to cefazolin⁴ ⁵
Only patients with a history of anaphylactic reaction to cefazolin or a history of Stevens-Johnson Syndrome or other severe, delayed reaction to beta-lactams should use alternative agents
Stevens Johnson Syndrome, Toxic Epidermal Necrolysis, or Drug Reaction with Eosinophilia and System Symptoms (DRESS)
Anaphylaxis to cefazolin
Anaphylaxis to penicilin
Non-severe cephalosporin reaction
Delayed rash more than 24 hours after taking drug
Itching
GI intolerance
Unknown reaction or patient unable to recall
References